Ligation device

Abstract

The present invention aims to provide a ligature device in which a clamp unit is easily attached to a sheath and the clamp unit is not easily detached from the sheath when attached. In the ligature device (1), a connection mechanism (2) including a first arm (311) and a second arm (312), a pressing tube (7), an operation wire (5), a sheath (6), and a first connector (21) and a second connector (22) that are connected to each other so that the pressing tube (7) is engaged with the sheath (6) is configured to be switched by the operation wire (5) to a release form in which the engagement of the pressing tube (7) with the sheath (6) is released and an engagement form in which the pressing tube (7) is engaged with the sheath (6).

Description

[0001] This application is a divisional application of International Application No. PCT / JP2018 / 048599 (National Application No. 201880100286.7) filed on December 28, 2018 (entered in the National Phase on June 17, 2021), the International Application No. PCT / JP2018 / 048599 (National Application No. 201880100286.7) being entitled "Ligation device and engagement method". TECHNICAL FIELD

[0002] The present application relates to a ligation device and an engagement method. BACKGROUND

[0003] In order to perform closure, hemostasis, or the like of an opening generated in a biological tissue, an endoscope clip device that ligates a target tissue using a clip is known (for example, Patent Literature 1). The endoscope clip device inserts a sheath into a channel of an endoscope and inserts into a body via the channel.

[0004] In the endoscope clip device of Patent Literature 1, a loop pusher coil is inserted through the sheath, and a clip closing ring of a clip is detachably fitted in a loop support member fixed to a top end of the loop pusher coil. The clip is deformed by pulling a base end portion of the clip into the clip closing ring, and the arms of the clip are opened and closed. The target tissue is gripped by the clip, and the base end of the clip is further pulled into the clip closing ring, so that the target tissue is ligated by the clip. Thereafter, the clip closing ring is detached from the loop support member, and the clip and the clip closing ring are left in the body.

[0005] Prior Art Documents

[0006] Patent Documents

[0007] Patent Literature 1: Japanese Patent Application Publication No. 2002-360591 SUMMARY

[0008] Problems to be Solved by the Invention

[0009] The operation of mounting the clip to the top end of the sheath is desired to be a simple operation. On the other hand, when the clip is opened and closed, the clip is advanced and retracted relative to the clip closing ring by the operation of the operation wire. Therefore, it is desired to stably hold the clip and the clip closing ring to the top end of the sheath.

[0010] However, in the case where the clip closing ring is fitted to the loop pusher coil as in the endoscope clip device of Patent Literature 1, the ease of mounting the clip closing ring to the loop pusher coil and the difficulty of detaching the clip closing ring become a trade-off relationship.

[0011] The present application has been achieved in view of the above-described circumstances, and has an object to provide a ligation device and a ligation method in which a clip unit is easily attached to a sheath and the clip unit is not easily detached from the sheath at the time of attachment.

[0012] Means for Solving the Problems

[0013] The ligation device according to the first aspect of the present application includes a first arm, a second arm capable of approaching the first arm, a pressing tube into which at least either of the first arm and the second arm is inserted, an operation wire connected to at least either of the first arm and the second arm, a sheath for housing the operation wire, and a connection mechanism having a first connection member and a second connection member which are connected to each other so that the pressing tube is engaged with the sheath, the connection mechanism being configured to be switched by the operation wire between a release mode in which the engagement of the pressing tube with the sheath is released and an engagement mode in which the pressing tube is engaged with the sheath.

[0014] According to the ligation device according to the first aspect of the present application, the second aspect of the present application can also be that the first connection member is movable to a radially outer side of the sheath by the operation wire, and the connection mechanism is switched from the engagement mode to the release mode by movement of the first connection member to the radially outer side.

[0015] According to the ligation device according to the second aspect of the present application, the third aspect of the present application can also be that the first connection member is configured to be moved to the radially outer side of the sheath by a pulling operation of the operation wire.

[0016] According to the ligation device according to the second aspect of the present application, the fourth aspect of the present application can also be that the first connection member has a leg portion having a first leg and a second leg which are movable in a direction in which they approach each other and a direction in which they separate from each other, the second connection member is engaged with the leg portion by the first leg and the second leg approaching each other, and the leg portion is configured to separate the first leg and the second leg by an operation of the operation wire.

[0017] According to the ligation device according to the fourth aspect of the present application, the fifth aspect of the present application can also be that the first connection member is provided to the sheath, and the second connection member is provided to the pressing tube.

[0018] According to the ligation device according to the fourth aspect of the present application, the sixth aspect of the present application can also be that the first connection member is provided to the pressing tube, and the second connection member is provided to the sheath.

[0019] According to the seventh aspect of the present application, the ligature device according to the fifth aspect can also include a large diameter portion fixed to the operation wire and having an outer diameter larger than that of the operation wire, and a narrow portion provided to the first connecting member, the minimum separation distance between the first leg and the second leg being smaller than the outer diameter of the large diameter portion and larger than the outer diameter of the operation wire, the first connecting member separating the first leg and the second leg by pressing the narrow portion with the large diameter portion of the operation wire.

[0020] The engagement method according to the eighth aspect of the present application engages the pressing tube and the sheath in a ligature device including a first arm, a second arm accessible to the first arm, the pressing tube into which at least either of the first arm and the second arm is inserted, an operation wire connected to at least either of the first arm and the second arm, the sheath for accommodating the operation wire, a first leg and a second leg provided to a distal end of the sheath, a large diameter portion provided to the operation wire and having an outer diameter larger than that of the operation wire, and a narrow portion provided to the sheath, the minimum separation distance between the first leg and the second leg being smaller than the outer diameter of the large diameter portion and larger than the outer diameter of the operation wire, wherein the engagement method includes the following steps: a first step of abutting the large diameter portion against the narrow portion by moving the operation wire in the length axis direction; a second step of separating the first leg and the second leg by moving the operation wire to press the large diameter portion against the narrow portion after the first step; a third step of arranging the pressing tube between the first leg and the second leg after the second step; and a fourth step of engaging the sheath and the pressing tube with the first leg and the second leg by moving the operation wire in a direction opposite to the moving direction in the first step to bring the first leg and the second leg close to each other after the third step.

[0021] The ligature device according to the ninth aspect of the present application includes a first arm, a second arm accessible to the first arm, a pressing tube into which at least either of the first arm and the second arm is inserted, an operation wire connected to at least either of the first arm and the second arm, a sheath for accommodating the operation wire, and a connecting mechanism having a first connecting member and a second connecting member connected to each other to engage the pressing tube to the sheath, the connecting mechanism configured to be switched to a release mode in which the pressing tube and the sheath are disengaged and an engagement mode in which the pressing tube is engaged to the sheath by rotation of the pressing tube with respect to the sheath or rotation of the sheath with respect to the pressing tube.

[0022] According to the ligature device of the ninth technical solution, the tenth technical solution of the present application can also be that the first connecting member is provided on the sheath and has a groove portion extending along the circumferential direction around the length axis of the sheath, the second connecting member is provided on the pressure tube and has a protrusion capable of being inserted into the groove portion, the protrusion is inserted into the groove portion by rotating the pressure tube relative to the sheath around the length axis, and the connecting mechanism is configured to become the engaged state by the protrusion being clamped in the groove portion.

[0023] According to the ligature device of the ninth technical solution, the eleventh technical solution of the present application can also be that the first connecting member is provided on the pressure tube and has a groove portion extending along the circumferential direction around the length axis of the pressure tube, the second connecting member is provided on the sheath and has a protrusion capable of being inserted into the groove portion, the protrusion is inserted into the groove portion by rotating the sheath relative to the pressure tube around the length axis, and the connecting mechanism is configured to become the engaged state by the protrusion being clamped in the groove portion.

[0024] According to the ligature device of the ninth technical solution, the twelfth technical solution of the present application can also be that the connecting mechanism has a thread combination structure between an external thread and an internal thread, and can be switched to the released state and the engaged state by rotating the pressure tube relative to the sheath.

[0025] Effects of the Invention

[0026] The ligature device and the engaging method of the present application have the advantages that the clamp unit is easy to be installed on the sheath, and the clamp unit is not easy to be separated from the sheath during installation. BRIEF DESCRIPTION OF DRAWINGS

[0027] FIG. 1A FIG. 1 is a partial cross-sectional view showing a ligature device of a first embodiment.

[0028] FIG. 1B FIG. 2 is a partial cross-sectional view of a clamp unit, which is observed from the direction of an arrow A shown in FIG. 1. FIG. 1A

[0029] FIG. 2 FIG. 5 is a side view showing a connecting mechanism of the ligature device of the first embodiment.

[0030] FIG. 3 FIG. 6 is a perspective view showing the connecting mechanism of the ligature device of the first embodiment.

[0031] FIG. 4 FIG. 7 is a cross-sectional view along a line IV-IV shown in FIG. 1. FIG. 1A

[0032] FIG. 5 ​​is a schematic view showing a use state of the ligature device of the first embodiment.

[0033] FIG. 6 is a flowchart showing the engagement method of the ligature device of the first embodiment.

[0034] FIG. 7 is a schematic view showing a use state of the ligature device of the first embodiment.

[0035] FIG. 8 is a perspective view showing the connection mechanism of the ligature device of the second embodiment.

[0036] FIG. 9 is a perspective view showing the connection mechanism of the ligature device of the second embodiment.

[0037] FIG. 10 is a schematic view showing the engagement method of the ligature device of the second embodiment.

[0038] FIG. 11 is a schematic view showing a use state of the ligature device of the second embodiment.

[0039] FIG. 12 is a schematic view showing a use state of the ligature device of the second embodiment.

[0040] FIG. 13 is a schematic view showing the connection mechanism of the ligature device of the third embodiment.

[0041] FIG. 14 is a schematic view showing the connection mechanism of the ligature device of the third embodiment.

[0042] FIG. 15 is a schematic view showing a use state of the ligature device of the third embodiment.

[0043] FIG. 16 is a perspective view showing a modification example of the connection mechanism of the ligature device of the first embodiment.

[0044] FIG. 17 is a partial cross-sectional view showing a modification example of the ligature device of the first embodiment. DETAILED DESCRIPTION

[0045] (First Embodiment)

[0046] Reference Signs FIGS. 1A to 9 The ligature device and the engagement method of the first embodiment will be described. FIG. 1A is a general view showing the ligature device 1 of the present embodiment. FIG. 2 is a side view showing the connection mechanism 2 of the ligature device 1. FIG. 3 is a perspective view showing the connection mechanism 2 of the ligature device 1. FIG. 4is along the FIG. 1A a cross-sectional view taken along the IV-IV line shown in Fig. 1.

[0047] The ligation device 1 of the present embodiment is a device that is inserted into the body via a treatment instrument channel of an endoscope to ligate the clip unit 4 to a tissue in the body. As shown in Fig. 1, the ligation device 1 includes the clip unit 4, a sheath 6, an operation wire 5, a connection mechanism 2, and an operation portion. FIG. 1A

[0048] In the following description, a center line in the length direction of the ligation device 1 in a state where the ligation device 1 extends in a straight line is referred to as a length axis C. The side of the operation portion 50 of the ligation device 1 is referred to as a proximal side, and the side opposite to the proximal side in the direction of the length axis C and on which the clip unit 4 is provided is referred to as a distal side.

[0049] As shown in Figs. 1 and 2, the clip unit 4 has an arm member 3 and a pressing tube 7. The arm member 3 has a first arm 311 and a second arm 312. The arm member 3 is provided with a connection portion 33 on the proximal side of the first arm 311 and the second arm 312. FIG. 1A FIG. 1B As shown in Figs. 1 and 2, the clip unit 4 has an arm member 3 and a pressing tube 7. The arm member 3 has a first arm 311 and a second arm 312. The arm member 3 is provided with a connection portion 33 on the proximal side of the first arm 311 and the second arm 312.

[0050] The arm member 3 is made of, for example, a thin and long plate of metal such as stainless steel, cobalt-chromium alloy, titanium, or the like. The arm member 3 is formed with the connection portion 33 of the letter U shape that is formed by bending the middle portion of the thin and long plate in the thickness direction, and the both end portions of the plate become the first arm 311 and the second arm 312. The first arm 311 and the second arm 312 are configured to maintain an open state in a natural state.

[0051] As shown in Figs. 1 and 2, the clip unit 4 has an arm member 3 and a pressing tube 7. The arm member 3 has a first arm 311 and a second arm 312. The arm member 3 is provided with a connection portion 33 on the proximal side of the first arm 311 and the second arm 312. FIG. 1B The end portions of the first arm 311 and the second arm 312 on the side opposite to the connection portion 33 are formed with claw portions 32 that are bent in the direction of approaching each other. The pair of arms 311 and 312 are imparted with a habit of bending in the direction of separating from each other from the connection portion 33 side toward the claw portions 32 side.

[0052] The pressing tube 7 is a cylindrical member having an insertion hole 70 that penetrates in the direction of the length axis C. The insertion hole 70 is a circular hole that is configured to communicate a first insertion hole 71 formed on the proximal side and a second insertion hole 72 formed on the distal side.

[0053]

[0054] ​​​The opening diameter of the first insertion hole 71 is larger than that of the second insertion hole 72. A flange 73 is formed at the boundary between the first and second insertion holes 71, 72, protruding radially inward in an annular shape. A distal wall 74 is formed extending outward from a proximal end 732 of the flange 73 in a direction perpendicular to the longitudinal axis C.

[0055] The second insertion hole 72 has an opening size capable of inserting the proximal region of the arm member 3. A tapered surface 76 that slightly widens toward a distal end surface 75 of the pressure tube 7 is formed at a distal end portion of the second insertion hole 72.

[0056] For example, the pressure tube 7 is made of a metal material such as stainless steel, titanium alloy (Ti-6AL-4V, etc.), or cobalt-chromium alloy, or a high-rigidity resin material with appropriate elasticity such as polyphthalamide (PPA) or polyamide (PA).

[0057] The connecting member 9 connects the arm member 3 and the operating wire 5. The connecting member 9 is inserted into the insertion hole 70 of the pressure tube 7 and is located on the proximal end of the arm member 3. The connecting member 9 includes a main body 90, a wire engaging portion 91, and a hook 92. The wire engaging portion 91 is located on the proximal end of the main body 90, and the hook 92 is located on the distal end of the main body 90.

[0058] The wire engaging portion 91 includes an engaging hole 911, a pair of engaging arms 912, and a locking portion 913. The engaging hole 911 is a hole opening at the proximal end of the main body 90 and is sized to accommodate the connector 51 of the manipulation wire 5, described later. The pair of engaging arms 912 are each configured to bend radially outward from the main body 90. A locking portion 913 is provided at each proximal end of the pair of engaging arms 912. The locking portion 913 is positioned opposite the engaging hole 911 and covers the hole opening.

[0059] The hook 92 is provided so as to protrude in a distal direction relative to the main body 90 . FIG. 1B It is from FIG. 1A The figure is viewed in the direction of arrow A. Hook 92 has a hook shape capable of retaining connection portion 33 of arm member 3. Specifically, hook 92 includes a proximal portion 923 connected to main body 90, and a first hook 921 and a second hook 922 that retain connection portion 33. A gap is formed between first hook 921 and second hook 922 to match the shape of connection portion 33. The longitudinal cross-sectional area of ​​hook 92, perpendicular to longitudinal axis C, is smaller than the longitudinal cross-sectional area of ​​main body 90.

[0060] The arm member 3 and the link member 9 are engaged in the through hole 70 of the pressure tube 7. Specifically, the first hook 921 of the link member 9 is arranged on the inner side of the bent portion of the connecting portion 33 of the arm member 3, the connecting portion 33 is inserted in the gap between the first hook 921 and the second hook 922, and is inserted into the insertion hole 70 in this state. With this structure, in the through hole 70, the hook 92 does not come off from the connecting portion 33 in the length axis C direction and the radial direction of the pressure tube 7, and the arm member 3 and the link member 9 are engaged.

[0061] The second insertion hole 72 has a size that allows the proximal region of the engaged arm member 3 and the link member 9 to advance and retreat in the length axis C direction. As will be described later in detail, the arm member 3 and the link member 9 can advance and retreat in the second insertion hole 72 in accordance with the advance and retreat of the operation wire 5 linked to the link member 9. The arm member 3 is configured so that the pair of arms 311, 312 can be opened and closed in accordance with the relative position of the arm member 3 to the second insertion hole 72 in the length axis C direction.

[0062] The operation portion 50 includes an operation main body 501 and a slider 502. The slider 502 is configured to be slidable with respect to the operation main body 501 in the length axis C direction.

[0063] The proximal end of the operation wire 5 is fixed to the slider 502 of the operation portion 50, and the connector 51 is fixed to the distal end of the operation wire 5. The operation wire 5 is formed of a single wire or a twisted wire made of metal. The operation wire 5 is inserted through the sheath 6.

[0064] The connector 51 is a member that links the arm member 3 and the operation wire 5. The connector 51 has a linking end 511, a large diameter portion 512, an engaged portion 513, and a recessed portion 514.

[0065] The linking end 511 has a cylindrical shape into which the distal end of the operation wire 5 is inserted and fixed. The large diameter portion 512 is located at a position distal from the linking end 511. The large diameter portion 512 has a cylindrical shape. The outer diameter of the large diameter portion 512 is larger than that of the linking end 511. Between the large diameter portion 512 and the linking end 511, there is a tapered portion 515 that expands in diameter from the linking end 511 toward the large diameter portion 512.

[0066] The recessed portion 514 is located between the proximal end of the engaged portion 513 and the linking end 511. The recessed portion 514 has a cylindrical shape with a smaller outer diameter than the engaged portion 513 and the large diameter portion 512. The engaged portion 513 is provided at the distal end of the connector 51. The engaged portion 513 has a conical shape that protrudes in the length axis C direction from the distal end surface of the large diameter portion 512, and a pointed end 516 is arranged distal to the engaged portion 513.

[0067] The connecting mechanism 2 is a mechanism that engages the pressure tube 7 with the distal end of the sheath 6. The connecting mechanism 2 includes a first connecting member 21 and a second connecting member 22. The first connecting member 21 and the second connecting member 22 can be connected to each other, with the first connecting member 21 functioning as an engaging portion and the second connecting member 22 functioning as an engaged portion. It is sufficient for one of the first connecting member 21 and the second connecting member 22 to be located on the pressure tube 7 and the other on the distal end of the sheath 6. In this embodiment, an example is shown in which the first connecting member 21 is located on the sheath 6 and the second connecting member 22 is located on the pressure tube 7.

[0068] The sheath 6 is a flexible, elongated tubular member. A conduit 61 is formed along the entire length of the sheath 6 along the longitudinal axis C. The sheath 6 is a coiled sheath formed by tightly winding a wire made of stainless steel, such as SUS301, around the longitudinal axis C. The proximal end of the sheath 6 is connected to the operating body 501 of the operating portion 50. The conduit 61 opens at the distal end 62 of the sheath 6.

[0069] A distal tube 8 is fixed to the distal end 62 of the sheath 6. The distal tube 8 has a cylindrical shape with an inner diameter and an outer diameter substantially equal to those of the sheath 6. The distal tube 8 is provided with a first connector 21. The first connector 21 includes a leg portion 80. The leg portion 80 is configured to include a first leg 81 and a second leg 82.

[0070] like FIG. 2 and FIG. 3 As shown, the first leg 81 and the second leg 82 are integrally formed with the distal cylinder 8 at opposing positions on the circumference of the distal cylinder 8. A pair of slits 84 are formed at opposing positions on the circumference of the distal cylinder 8. The pair of slits 84 extend from the distal end 88 of the distal cylinder 8 toward the proximal side along the longitudinal axis C. The proximal end 811 of the first leg 81 and the proximal end 821 of the second leg 82 are connected to the proximal ends of the respective slits 84. The first leg 81 and the second leg 82 have the same shape and are symmetrically arranged across the longitudinal axis C.

[0071] The first and second legs 81, 82 have an elongated plate shape, with proximal ends 811, 821 fixed to the distal tube 8. The distal locking claws 803 are formed by free ends. Therefore, the first and second legs 81, 82 are configured to elastically deform inward and outward directions of the distal tube 8, allowing the pair of locking claws 803 to move in both directions of separation and convergence. The first and second legs 81, 82 are bent at multiple locations along their lengths. The first and second legs 81, 82 have an inward protrusion 801, an outward parallel portion 802, and a locking claw 803.

[0072] like FIG. 1AAs shown, the inner protrusion 801 is formed to protrude from the proximal end 811 of the first leg 81 and the proximal end 821 of the second leg 82 toward the inside of the distal tube 8. The inner protrusion 801 is formed by the first leg 81 and the second leg 82 protruding inwardly and approaching each other, and is bent in the distal direction at the closest position to form an inner parallel portion 804 extending in parallel. The distal end of the inner parallel portion 804 is bent outward and tilted toward the outside of the distal tube 8.

[0073] The outer parallel portion 802 is located on the distal side of the inner protrusion 801. The outer parallel portion 802 is formed by extending parallel to each other along the longitudinal axis C at a position outward from the outer peripheral surface of the distal tube 8.

[0074] The locking claw 803 is formed by bending the first leg 81 and the second leg 82 at a substantially right angle inward at the distal end of the outer parallel portion 802 and extending them toward each other. The locking claw 803 protrudes inward from the outer parallel portion 802 to a length sufficient to slightly protrude into the first insertion hole 71 of the pressure tube 7. Alternatively, the locking claw 803 may protrude enough to remain within the first insertion hole 71.

[0075] like FIG. 1A As shown, the distance between the legs 80 is smallest at the inner parallel portions 804 of the first and second legs 81, 82. The inner parallel portions 804 of the first and second legs 81, 82 form narrowed portions 808 of the legs 80. Narrowed portions 808 have a clearance narrower than the opening of the conduit 61 but sufficient to allow the operating wire 5 to advance and retract without contact.

[0076] The second connector 22 is formed by a pair of through holes 77 radially extending through the inner and outer sides of the pressure tube 7 at the first insertion hole 71. The pair of through holes 77 are formed at opposite positions on the circumference of the pressure tube 7. Each through hole 77 has an opening into which the locking claw 803 can be inserted.

[0077] Ligation device 1 FIG. 1A As shown, the proximal end of the sheath 6 is connected to the operating body 501, and the proximal end of the operating wire 5 is connected to the slider 502. The operating wire 5 is housed in the tube 61 of the sheath 6. The operating wire 5 extends to the distal end of the sheath 6. The operating wire 5 can be advanced and retracted relative to the sheath 6 by sliding the slider 502 relative to the operating body 501.

[0078] The connector 51 of the operation wire 5 is arranged at a position on the distal side of the narrow portion 808 of the distal tube 8 (first connector 21 ) provided in the distal portion of the sheath 6 .

[0079] like FIG. 1AAs shown, the operating wire 5 is connected to the slider 502 of the operating portion 50, housed in the conduit 61 of the sheath 6, and extends to the distal end. The operating wire 5 passes through the gap between the inner parallel portions 804 of the narrow portion 808. The large-diameter portion 512 of the connector 51 of the operating wire 5 is positioned distally relative to the narrow portion 808 of the first connector 21.

[0080] The operating wire 5 is configured to be able to advance and retreat within the sheath 6 by sliding the slider 502 relative to the operating body 501. Since the gap in the narrow portion 808 (the distance between the inner parallel portions 804) is wide enough to allow the operating wire 5 to advance and retreat without contact, the advancement and retreat of the operating wire 5 is not hindered.

[0081] The ligation device 1 is configured to switch the sheath 6 and the pressure tube 7 between a released state and an engaged state using the connection mechanism 2. The engaged state is when the pressure tube 7 is engaged with the sheath 6 via the connection mechanism 2. The released state is when the pressure tube 7 and sheath 6 are not engaged. Therefore, the released state includes a state in which the pressure tube 7 and sheath 6 are released after the engaged state, and a state before the pressure tube 7 and sheath 6 are engaged.

[0082] The clamp unit 4 is detachably mounted on the distal side of the sheath 6. In the engaged configuration, the proximal end of the compression tube 7 abuts the distal end 88 of the distal tube 8 of the sheath 6, and the compression tube 7 and sheath 6 are coaxially arranged. In this configuration, the locking claws 803 of the legs 80 are inserted into the pair of through-holes 77 of the compression tube 7, and the compression tube 7 is gripped by the legs 80.

[0083] Since the legs 80 are biased toward the pair of locking claws 803 when no external force is applied, the engagement of the pressure tube 7 is stably maintained. In addition, since the outer parallel portion 802 is disposed close to the outer peripheral surface of the pressure tube 7 in the engaged state, the pressure tube 7 and the sheath 6 can be maintained coaxially.

[0084] The engaged portion 513 of the connector 51 of the operating wire 5 is inserted into the engaging hole 911 of the connecting member 9, and the engaged portion 513 is retained by a pair of engaging arms 912, thereby connecting the clamp and the operating wire 5 via the connecting member 9. In the engaged state, since the pressure tube 7 is engaged with the sheath 6, the arm member 3 and the connecting member 9 move relative to each other along the longitudinal axis C as the operating wire 5 advances and retreats.

[0085] like FIG. 5 As shown, when the first leg 81 and the second leg 82 are separated and opened, the locking claws 803 are not inserted into the pair of through holes 77 (second connector 22), and the clamp unit 4 is in a released state, not engaged with the sheath 6. As will be described in detail later, the released state and the engaged state can be switched by advancing and retreating the operating wire 5.

[0086] Next, the use state and the engagement method of the ligation device 1 will be described.

[0087] FIG. 6 is a flowchart showing the engagement method of the present embodiment.

[0088] First, in order to mount the clamp unit 4 to the distal end of the sheath 6, the ligation device 1 is brought to the released state. The operator pulls the operation wire 5 to the proximal side, so that the large diameter portion 512 abuts against the narrow portion 808 (first step S1). The diameter of the large diameter portion 512 of the connector 51 is larger than the separation distance of the narrow portion 808 in the natural state. Therefore, in the state where the leg portions 80 are closed, the large diameter portion 512 does not move to the position closer to the proximal side than the narrow portion 808.

[0089] After the first step S1, as shown in FIG. 5 , the operation wire 5 is further pulled to the proximal side, so that the large diameter portion 512 is pressed against the narrow portion 808, and the first leg 81 and the second leg 82 are separated (second step S2). When the operator slides the slider 502 to the proximal side to further retreat the operation wire 5, the tapered portion 515 first enters the narrow portion 808, and then the large diameter portion 512 presses the narrow portion 808 from the distal side of the narrow portion 808. As a result, as shown in FIG. 7 , the pair of inner parallel portions 804 are elastically deformed in the separating direction, the first leg 81 and the second leg 82 are separated and protrude to the outside of the distal cylinder 8, and the outer diameter of the first connector 21 becomes large.

[0090] After the second step S2, the pressure tube 7 is arranged between the first leg 81 and the second leg 82 (third step S3). The clamp unit 4 is arranged on the distal side of the distal cylinder 8.

[0091] The clamp unit 4 is housed in the case 200 before being mounted to the sheath 6 (refer to FIG. 7 ). The clamp unit 4 is preliminarily housed in the housing portion 212 of the case 200 in the state where the arms 311, 312 of the distal region of the arm member 3 protrude to the distal side of the pressure tube 7. In the state where the clamp unit 4 is housed, a space for the sheath 6 to be inserted is formed at the position closer to the proximal side than the pressure tube 7.

[0092] The case 200 is brought close to the distal cylinder 8 of the sheath 6, and as shown in FIG. 7 , the distal end 88 of the distal cylinder 8 is inserted into the opening 215 on the proximal side of the housing portion 212 of the case 200. The sheath 6 is advanced to the case 200 side, and the distal end 88 of the distal cylinder 8 abuts against the proximal end of the pressure tube 7.

[0093] After the third step S3, the sheath 6 is set to the engaged state (fourth step S4). When the operator advances the slider 502 to advance the operation wire 5 to the distal side, the large-diameter portion 512 moves to the distal side, and the large-diameter portion 512 is separated from the narrow portion 808. As a result, the pressing of the leg portions 80 by the large-diameter portion 512 is released, and the first leg 81 and the second leg 82 are brought close to each other. A pair of slits 213 that communicate the inside and outside of the housing portion 212 and extend in the direction of the length axis C are formed at the proximal end of the cartridge 200. The pair of slits 213 are provided at positions corresponding to the pair of through holes 77 (second connecting members 22) of the pressing tube 7. The first leg 81 and the second leg 82 move in the direction of approaching each other, and each of the locking claws 803 passes through each of the slits 213 of the cartridge 200 to enter the through hole 77. As a result, the first leg 81 and the second leg 82 grip and engage the pressing tube 7, and the engaged state is achieved. After the engagement, the cartridge 200 is detached from the arm member 3.

[0094] Next, the ligation device 1 is inserted into the body via the treatment instrument channel of the endoscope by a well-known method, and the clip unit 4 is brought close to the tissue to be ligated by the arm member 3. In addition, since the pressing tube 7 is engaged with the sheath 6 by the connecting mechanism 2 (see FIG. 4 ), when the sheath 6 is rotated around the length axis C, the pressing tube 7 also rotates, and the orientation of the pair of arms 311, 312 of the arm member 3 around the length axis C can be adjusted.

[0095] After that, when the slider 502 of the operation portion 50 is advanced, the operation wire 5 is advanced with respect to the sheath 6. With the advancement of the operation wire 5, the clip 3 is advanced with respect to the pressing tube 7, and the pair of arms 311, 312 protrude to the distal side from the housing portion 212. The portions of the pair of arms 311, 312 that protrude to the distal side from the housing portion 212 are released from the pressing force of the housing portion 212 and open in the direction of moving away from each other.

[0096] On the other hand, when the slider 502 is operated to retreat with respect to the operation main body 501 to retreat the operation wire 5, the arm member 3 moves to the proximal side in the second through hole 72. As a result, the proximal portions of the pair of arms 311, 312 are inserted into the second through hole 72, the pair of arms 311, 312 move in the direction of approaching each other, and the arm member 3 starts to close.

[0097] Since the clamp unit 4 is configured to engage the sheath 6 and the pressure tube 7 with the connecting member 9, the operation wire 5 is able to advance and retreat in this state, and therefore the arm member 3 is able to advance and retreat relative to the pressure tube 7. As a result, the tissue can be re-grasped by the arm member 3. That is, when the connecting portion 33 is positioned in the second through-hole 72, the arm member 3 is able to advance and retreat relative to the pressure tube 7. Thus, when the arm member 3 is relatively advanced relative to the pressure tube 7 after temporarily grasping the tissue with the pair of claw portions 32 of the arm member 3, the pair of arms 311, 312 can be opened again, and the state in which the pair of claw portions 32 grasps the tissue can be released. Also, when the arm member 3 is relatively retreated relative to the pressure tube 7 after the pair of arms 311, 312 is opened and the arm member 3 is brought close to the tissue again, the tissue can be grasped again with the pair of claw portions 32.

[0098] When the operator holds the tissue in the desired state with the arm member 3, the slide 502 is retreated, and the operation wire 5 and the arm member 3 are retreated. When the arm member 3 is retreated, at the proximal portion of the arm member 3, as the locking piece 34 passes through the flange 73, the annular shape of the connecting portion 33 is reduced in diameter, and then the locking piece 34 reaches the first through-hole 71. When the locking piece 34 enters the first through-hole 71, the annular shape of the connecting portion 33 is expanded again, and the distal side edge of the locking piece 34 is locked against the distal wall 74 of the first through-hole 71. As a result, the advancement of the arm member 3 relative to the pressure tube 7 is restricted, and the pressure tube 7 is engaged with the arm member 3.

[0099] When the operation wire 5 is further pulled in the state in which the pair of arms 311, 312 cannot retreat in the second insertion hole 72, a tension is applied to the connecting member 9, the hook 92 is elastically deformed, and the engagement of the connecting portion 33 of the arm member 3 with the hook is released. At this series of retreat operations, the large-diameter portion 512 presses the narrow portion 808 again, the leg portions 80 are opened outward, and the engagement of the pair of through-holes 77 of the pressure tube 7 with the leg portions 80 is released. That is, by the pulling operation of the operation wire 5, the engagement of the hook 92 with the connecting portion 33 of the arm member 3 and the engagement of the locking claw 803 with the through-hole 77 (the engagement of the first connecting member 21 with the second connecting member 22) are substantially simultaneously released. As a result, the clamp unit 4 is detached from the sheath 6 and the operation wire 5, and the tissue is ligated with the clamp unit 4.

[0100] After the tissue is ligated with the clamp unit 4, the ligation device 1 is pulled out to the outside of the body, and the above-described release mode and engagement mode operations are performed as necessary, and the second clamp unit 4 is again loaded at the distal end of the sheath 6. When the tissue is ligated at a plurality of sites with a plurality of clamp units 4, the clamp units can be continuously loaded without replacing the ligation device 1.

[0101] With the ligature device 1 of the present embodiment, since the connecting mechanism 2 is provided, the release form and the engagement form can be switched by the operation of the operation wire 5. Thus, since the engagement and disengagement of the pressure tube 7 and the sheath 6 can be switched by the operation of the operation portion 50, it is easy to attach the clamp unit 4 to the sheath 6. Further, since the connecting mechanism 2 engages the pressure tube 7 to the sheath 6 by linking the first connecting member 21 and the second connecting member 22, the clamp unit 4 is not easily detached from the sheath 6 when attached to the sheath 6.

[0102] With the ligature device 1 of the present embodiment, in the release form, the first connecting member 21 is configured to move to the radial outside of the distal tube 8 (the sheath 6) by the operation wire 5. That is, since the first connecting member 21 moves to the direction in which the leg portion 80 is spread to the outside of the distal tube 8, the pressure tube 7 does not interfere with the first connecting member 21, and the pressure tube 7 can be smoothly arranged on the distal side of the sheath 6.

[0103] With the ligature device 1 of the present embodiment, the first connecting member 21 is configured to move to the radial outside of the sheath 6 by the operation of pulling the operation wire 5 to the proximal side. Thus, the engagement of the pressure tube 7 and the sheath 6 can be released by the simple operation of pulling the operation wire 5.

[0104] With the ligature device 1 of the present embodiment, the leg portion 80 in which the first leg 81 and the second leg 82 approach each other engages the second connecting member 22, and the engagement of the leg portion 80 and the second connecting member 22 is released when the first leg 81 and the second leg 82 are separated by the operation of the operation wire 5. Thus, by the advance and retreat operation of the operation wire 5, the engagement form and the release form of the first connecting member 21 and the second connecting member 22 can be easily switched.

[0105] With the ligature device 1 of the present embodiment, the operation wire 5 is arranged between the first leg 81 and the second leg 82, and as the operation wire 5 is pulled, the large diameter portion 512 presses the narrow portion 808, and the first leg 81 and the second leg 82 are separated. Thus, by the simple operation of pulling the operation wire 5, the engagement of the first connecting member 21 and the second connecting member 22 is released, and the pressure tube 7 is easily detached from the sheath 6.

[0106] With the ligature device 1 of the present embodiment, the first connecting member 21 is provided to the sheath 6, and the second connecting member 22 is provided to the pressure tube 7. By moving the leg portion 80 to the radial outside by the operation of the operation wire 5, the first connecting member 21 can be arranged on the sheath 6 side. That is, the first connecting member 21 as a movable mechanism is arranged on the sheath 6, and the second connecting member 22 as an engaged portion is arranged on the pressure tube 7. As a result, the pressure tube 7 left in the body can be made into a simple structure.

[0107] In the present embodiment, an example is shown in which the large-diameter portion 512 is provided on the distal side of the narrow portion 808, and the large-diameter portion 512 is pressed against the narrow portion 808 on the proximal side by the retreat of the operation wire 5, and the pressing force of the large-diameter portion 512 against the narrow portion 808 opens the leg portion 80, but the structure in which the leg portion 80 is opened is not limited thereto. For example, a structure can also be such that, as in the modification shown in FIG. 10, the large-diameter portion 512a is provided separately from the connector 51 at a position in the operation wire 5 that is separated from the connector 51 on the proximal side, and the large-diameter portion 512a is provided on the proximal side of the narrow portion 808. In this case, by operation of advancing the operation wire 5 in the distal direction, a structure is obtained in which the large-diameter portion 512a pushes against the narrow portion 808 in the distal direction, and the leg portion 80 is opened. FIG. 17

[0108] (Second Embodiment)

[0109] Reference Signs FIGS. 8 to 12 A ligature device 1A of the second embodiment will be described. In the following description, common components to those already described in the first embodiment are denoted by the same reference signs, and repeated description will be omitted. FIG. 8 And FIG. 9 is a perspective view showing the connection mechanism 2A of the ligature device 1A of the present embodiment. FIG. 8 Description of the pressure tube 7 is omitted. FIG. 9 Description of the clamp unit 4A is omitted.

[0110] The structure of the connection mechanism of the ligature device 1A of the present embodiment and the structure of the connection mechanism 9A of the clamp unit 4A differ from those of the first embodiment. The connection mechanism 2A of the present embodiment is provided with a first connection member 21 at the distal tube 8A and a second connection member 22 at the clamp unit 4. The distal tube 8A includes a substantially cylindrical tube portion 85 and a pair of locking pieces 86. The tube portion 85 is fixed to the distal end 62 of the sheath 6. As shown in FIG. 8 FIG. 9 As shown in FIG. 8, the pair of locking pieces 86 are provided so as to protrude to a position on the distal side of the tube portion 85 in the direction of the length axis C. The pair of locking pieces 86 are provided at positions that are diametrically opposed with respect to the central axis of the sheath 6.

[0111] Each of the locking pieces 86 is a plate-like member that is long in the direction of the length axis C and is curved along the arc shape of the outer peripheral portion of the tube portion 85. A hook portion 861 is formed at the distal end portion of each of the locking pieces 86. The hook portion 861 is formed by cutting a locking groove 863 (groove portion) that extends in the circumferential direction of the tube portion 85 from a side portion 862 in the direction of the length axis C of the locking piece 86. The pair of locking grooves 863 are open in different directions with respect to the circumferential direction of the sheath 6.

[0112] ​​The connecting member 9A of the clamp unit 4A has a main body 90A, a hook 92, and a shaft 93. The main body 90A has a cuboid shape elongated in the length axis C direction, and is formed with a slide hole 902 extending in the length axis C direction. The slide hole 902 penetrates between a pair of side walls of the main body 90A. A gap matching the shape of the connecting portion 33 is formed between a distal end of the main body 90A and the first hook 921, and the distal end of the main body 90A functions as the second hook 922.

[0113] The shaft 93 is a rod-shaped member longer in diameter than the pressure tube 7A. The shaft 93 is, for example, a rod-shaped member made of resin or metal. The shaft 93 penetrates the slide hole 902 from a direction intersecting the length axis C, and both end portions 931 (protrusions) protrude outward from the slide hole 902. The diameters of the both end portions 931 are slightly larger than the diameter of the intermediate region of the shaft 93.

[0114] As shown in FIG. 8, a pair of engagement holes 78A through which the shaft 93 penetrates are formed radially through the proximal end portion of the pressure tube 7. As shown in FIG. 9, the engagement holes 78A have a circular shape in side view. The engagement holes 78A are symmetrically formed at positions opposite each other across the central axis of the pressure tube 7. FIG. 9 FIG. 9 As shown in FIG. 8, a pair of engagement holes 78A through which the shaft 93 penetrates are formed radially through the proximal end portion of the pressure tube 7. As shown in FIG. 9, the engagement holes 78A have a circular shape in side view. The engagement holes 78A are symmetrically formed at positions opposite each other across the central axis of the pressure tube 7.

[0115] In FIG. 8 the illustration of the pressure tube 7 is omitted, but the shaft 93 penetrates the engagement holes 78A and the slide hole 902 in a state in which the main body 90A is inserted into the pressure tube 7. The opening diameter of the engagement holes 78A is slightly smaller than the both end portions 931 of the shaft 93. Therefore, the shaft 93 is not easily detached from the engagement holes 78A and the slide hole 902, and penetrates in a slidable manner within the slide hole 902.

[0116] Next, the use state of the ligature device 1 of the present embodiment will be described with reference to FIGS. 10 to 12

[0117] The shaft 93 penetrates the slide hole 902 and the engagement holes 78A, and the both end portions 931 protrude outward from the pressure tube 7. In a state in which the connecting portion 33 of the arm member 3 is disposed between the first hook 921 and the second hook 922, the connecting member 9A and the connecting portion 33 of the arm member 3 are inserted into the first insertion hole 71 of the pressure tube 7. The pressure tube 7 is brought close to the distal cylinder 8A in a state in which the engagement hole 911 of the connecting member 9A and the pair of engagement arms 912 protrude from the proximal end of the pressure tube 7. The pair of locking pieces 86 abut against the outer peripheral surface of the pressure tube 7, and are pushed outward in the peripheral direction by the pressure tube 7, thereby being fitted to the pressure tube 7 while being elastically deformed. As a result, the pressure tube 7 is disposed between the pair of locking pieces 86, and the both end portions 931 of the shaft 93 protrude to positions radially outward of the pair of locking pieces 86.

[0118] ​​When the operator rotates the sheath 6 clockwise about the longitudinal axis C with the ends 931 of the shaft 93 positioned proximate to the locking grooves 863, the ends 931 of the shaft 93 are inserted into the pair of locking grooves 863, and the connecting member 9A and the pair of locking pieces 86 are locked via the shaft 93. This results in the sheath 6 and the pressure tube 7 being engaged.

[0119] When the proximal end of the compression tube 7 abuts against the distal end of the distal tube 8A, the operating wire 5 is advanced, and the engaged portion 513 is pushed into the engaging hole 911 of the connecting member 9A, thereby connecting the operating wire 5 and the connecting member 9A.

[0120] In the engaged configuration, the clamp unit 4 is also engaged in a rotatable manner as the sheath 6 rotates about the longitudinal axis C. Since the sliding hole 902 is formed to extend along the longitudinal axis C, the connecting member 9A is configured to be able to advance and retreat relative to the sheath 6 and the pressure tube 7 when the operating wire 5 is advanced or retreated. Therefore, when the operating wire 5 is advanced, the pair of arms 311 and 312 of the arm member 3 open in a direction away from each other, and when the operating wire 5 is retreated, the pair of arms 311 and 312 approach each other, closing the arm member 3.

[0121] When the manipulation wire 5 is retracted after the tissue is grasped by the arm member 3, the connecting member 9A moves toward the proximal side and abuts against the distal end of the sliding hole 902 (see FIG. FIG. 11 (b) and FIG. 12 (b)). When the operating wire 5 is further retracted, as shown in FIG. FIG. 11 (c) and FIG. 12 As shown in (c), the shaft 93 bends, exerting a force on both ends 931 of the shaft 93, pulling them proximally. As a result, the shaft 93 is pressed and expanded, and the locking grooves 863 and the locking holes 78A are simultaneously retracted into the tube 61 of the sheath 6. As a result, the engagement between the both ends 931 of the shaft 93 and the locking holes 78A and the pair of hooks 861 is released. Subsequently, the first hook 921 flexes within the first insertion hole 71, releasing the engagement of the connector 33 by the hook 92. The compression tube 7 is disengaged, and the connection between the connecting member 9A and the clamp unit 4A is released.

[0122] According to the ligation device 1A of this embodiment, the clip unit 4 can be easily attached to the sheath 6 as in the first embodiment, and the clip unit 4 is unlikely to be detached from the sheath 6 during attachment.

[0123] According to the ligation device 1A of this embodiment, the engagement between the compression tube 7A and the sheath 6 can be released by a simple operation of rotating the sheath 6 about the longitudinal axis C. Furthermore, by rotating the sheath 6 about the longitudinal axis C and moving it forward and backward along the longitudinal axis C, the engaged and disengaged states of the first connector 21 and the second connector 22 can be easily switched.

[0124] (Third Embodiment)

[0125] Referring to FIG. 13 and FIG. 14 A ligature device 1B of the third embodiment will be described. FIG. 13 and FIG. 14 is a schematic view showing a connection mechanism of the ligature device 1B of the present embodiment. The connection mechanism 2B has a thread engagement structure between an external thread and an internal thread. As shown in FIG. 13 and FIG. 14 , an external thread portion 79 (first connecting member 21) having a thread formed on an outer peripheral surface of a proximal end portion of the pressure tube 7B is provided. An internal thread groove 83 (second connecting member 22) is provided on an inner peripheral surface of the distal cylinder 8B provided on the distal end 62 of the sheath 6.

[0126] FIG. 13 The state in which the external thread portion 79 of the pressure tube 7B and the thread groove 83 of the distal cylinder 8B are not engaged is the release mode. As shown in FIG. 14 , the state in which the external thread portion 79 is inserted into the distal cylinder 8B and thread-engaged with the thread groove 83 is the engagement mode. As shown in FIG. 14 and FIG. 15 , the pressure tube 7B is engaged with the distal cylinder 8B by the operation of the surgical operator holding the pressure tube 7B and the sheath 6 of the clamp unit 4 to thread-engage the pressure tube 7B in the distal cylinder 8B. When the surgical operator holding the pressure tube 7B and the distal cylinder 8B releases the thread engagement of the external thread portion 79 and the thread groove 83, the release mode is obtained.

[0127] With the ligature device 1B of the present embodiment, the release mode and the engagement mode can be switched by the rotation of the pressure tube 7B relative to the sheath 6. With the ligature device 1B of the present embodiment, since the connection mechanism 2 is provided, the release mode and the engagement mode can be switched by a simple operation. Further, when the clamp unit 4 is attached to the sheath 6, the pressure tube 7 is less likely to be detached from the sheath 6.

[0128] In the present embodiment, an example of the arm member 3 in which the first arm 311 and the second arm 312 are moved relative to the pressure tube 7 is shown, but the structure of the clamp is not limited thereto. For example, the clamp in which the first arm and the second arm are separately provided can be used.

[0129] In the present embodiment, an example in which the thread groove is provided on the distal cylinder 8B and the external thread portion is provided on the pressure tube 7B is shown, but the connection mechanism is not limited thereto. For example, the structure in which the thread groove is provided in the first housing portion 221 of the pressure tube 7B and the external thread portion is provided on the outer peripheral surface of the distal cylinder 8B, and the pressure tube 7B is engaged with the distal cylinder from the outside can be used.

[0130] In the first embodiment, an example is shown in which the pressing tube 7 is made to approach the distal side cylinder 8 from the distal side, but the direction in which the pressing tube 7 is made to approach the distal side cylinder 8 is not limited to this. For example, as shown in FIG. 16 the pressing tube 7 can be disposed between the first leg 81 and the second leg from a direction orthogonal to the length axis C of the sheath 6 in a state in which the leg portion 80 is opened. In the case of such a structure, for example, by making the operation of the link arm member 3 and the operation wire 5 to be such that the engaged portion 513 of the connector 51 is inserted into the engagement hole 911 of the link member 9 from a direction orthogonal to the length axis C of the sheath 6, it is possible to perform the linking of the arm member 3 and the operation wire 5 and the engagement of the pressing tube 7 and the sheath 6 simultaneously using a single operation.

[0131] In the first embodiment, an example is shown in which the first connecting member is provided to the sheath 6 and the second connecting member is provided to the pressing tube 7, but it is also possible for the first connecting member to be provided to the pressing tube and the second connecting member to be provided to the sheath.

[0132] The clamp unit 4 shown in the above embodiments is an example of a clamp unit that can be ligated in the body using the present ligating device, but the form of the clamp unit is not limited to this. For example, it can be a clamp unit that independently has two arms, and the like. The present ligating device can be appropriately applied to a clamp unit that can be recaptured.

[0133] The above describes the embodiments of the present application in detail with reference to the drawings, but the specific structure is not limited to this embodiment, and design changes and the like within the scope of the gist of the present application are also included.

[0134] Furthermore, the constituent elements shown in the above embodiments and each modification example can be appropriately combined to constitute.

[0135] Industrial Applicability

[0136] A ligating device that makes it easy to mount a clamp unit to a sheath and makes it difficult for the clamp unit to come off the sheath when mounted can be provided.

[0137] Explanation of Reference Numerals

[0138] 1, 1A, 1B, ligating device; 2, connecting mechanism; 3, arm member; 5, operation wire; 6, sheath; 7, pressing tube; 21, first connecting member; 22, second connecting member; 77, through hole (second connecting member); 311, first arm; 312, second arm; 51, large diameter portion; 80, leg portion; 81, first leg; 82, second leg; 808, narrow portion; 863, locking groove (groove portion, first connecting member).

Claims

1. A ligature device, wherein the ligature device comprises: a first arm; a second arm capable of approaching the first arm; a pressing tube into which at least a portion of the first arm and at least a portion of the second arm are inserted; a sheath for accommodating an operation wire; and a connecting mechanism including a locking portion that engages the pressing tube and the sheath and an elastically deformable portion that is elastically deformable in a direction intersecting a moving direction of the operation wire, a connector larger in diameter than the operation wire is provided at a tip end of the operation wire and is used to connect the operation wire to the first arm and the second arm, the engagement between the pressing tube and the sheath is released by pressing the connector against the elastically deformable portion, whereby the elastically deformable portion moves in a direction separating in a radial direction of the operation wire, the engagement between the pressing tube and the sheath can be released using the connector in a state in which the operation wire is connected to the first arm and the second arm using the connector.

2. The ligature device according to claim 1, wherein the elastically deformable portion is in an elongated plate shape.

3. The ligature device according to claim 1 or 2, wherein one end of the elastically deformable portion is a free end that is movable in a radial direction of the pressing tube or the sheath.

4. The ligature device according to claim 1 or 2, wherein two of the elastically deformable portions are formed in a manner facing each other in a radial direction of the pressing tube or the sheath.

5. The ligature device according to claim 3, wherein the elastically deformable portion has an inner protrusion that protrudes toward an inner side on which the operation wire is present.

6. The ligature device according to claim 5, wherein the elastically deformable portion has a minimum separation distance at a portion in which the inner protrusion is formed.

7. The ligature device according to claim 6, wherein the minimum separation distance is smaller than an outer diameter of the connector and larger than an outer diameter of the operation wire.

8. The ligature device according to claim 5, wherein the inner protrusion has an abutting portion that abuts against the connector, the abutting portion has a slope that inclines toward a radially inner side along a moving direction of the connector when the connector is abutting.

9. The ligature device according to claim 3, wherein the locking portion is formed at the free end of the elastically deformable portion.

10. The ligature device according to claim 9, wherein the locking portion is movable in a separating direction and an approaching direction by an elastic deformation of the elastically deformable portion.

11. The ligature device according to claim 9, wherein the locking portion is formed by bending the one end of the elastically deformable portion toward a radially inner side.

12. The ligature device according to claim 3, wherein the other end of the elastically deformable portion is fixed to the pressing tube or the sheath.

13. The ligature device according to claim 12, wherein the locking portion engages one of the pressing tube and the sheath to which the other end of the elastically deformable portion is not fixed.

Images