Treatment device for endoscope

Abstract

The clamping device includes a tubular member, a clip, and a joint structure. The clip has a first arm portion and a second arm portion. The joint structure includes a stepped connection portion and a hook structure, which connect the clip. The stepped connection portion includes a joint region connecting two side regions, and a width of the joint region of the stepped connection portion is smaller than a width of a first side region of the two side regions of the stepped connection portion. The hook structure includes two side surfaces connected by a hook surface, a surface of the joint region of the stepped connection portion is engaged with the hook surface of the hook structure, and each of the two side regions of the stepped connection portion is adjacent to a corresponding one of the two side surfaces of the hook structure.

Description

[0001] This application claims priority to provisional application number 63 / 141620 filed in the United States on January 26, 2021, the entire contents of which are hereby incorporated by reference. TECHNICAL FIELD

[0002] The present invention relates to an endoscope treatment device inserted into a body for ligating a tissue, and more particularly, to an endoscope treatment device having an improved clip unit. BACKGROUND

[0003] Various endoscope treatment devices are known. One type of device has a clip unit for ligating an opening formed in a tissue or a blood vessel. The existing ligation device includes a clip unit, a treatment device body, and a connecting member connecting the treatment device body to the clip unit. The clip unit is detachably mounted at a distal end of the treatment device body. The clip unit can include a clip body and a pressure tube housing the clip body. The clip body includes a pair of arm portions and an intermediate portion. The intermediate portion is provided at a proximal end of the pair of arm portions and connects the pair of arm portions.

[0004] The connecting member includes a hook portion provided at the distal end of the treatment device body. The intermediate portion of the clip unit engages with the hook portion of the connecting member. By virtue of the engagement, the clip unit is able to advance and retreat through the pressure tube by manipulating the treatment device body. In addition, the clip unit is able to rotate in the axial direction of the pressure tube, thereby adjusting the position of the pair of arm portions during the process of clamping the tissue.

[0005] However, the existing connecting member located between the clip and the treatment device body still has several defects. For example, the existing connecting member lacks sufficient strength to ensure the rotational movement of the clip unit in the axial direction of the pressure tube when the clip unit is rotated. For another example, the existing connecting member lacks sufficient strength to ensure the linear movement of the clip unit in the axial direction of the pressure tube when the clip unit is pulled by the operating wire. As a result, the clip unit can be unexpectedly detached from the hook portion of the treatment device body before the ligation process is successfully completed. SUMMARY

[0006] The present invention aims to provide an endoscope treatment device and a clip unit that can sufficiently solve one or more problems caused by the limitations and shortcomings of the existing endoscope treatment device and clip unit.

[0007] The present invention provides a clip device including a tubular member having an inner cavity and at least one open end; a clip including a first arm portion and a second arm portion, capable of sliding between a retracted position in which the first arm portion and the second arm portion are located in the inner cavity of the tubular member, and an extended position in which the first arm portion and the second arm portion extend from the open end of the tubular member; and an engagement structure provided inside the tubular member, including a step-like connecting portion and a hook-like structure, connecting the clip. The step-like connecting portion includes an engagement region connecting two side regions, the width of the engagement region of the step-like connecting portion being smaller than the width of a first side region of the two side regions of the step-like connecting portion. The hook-like structure includes two side surfaces connected by a hook surface. The surface of the engagement region of the step-like connecting portion engages the hook surface of the hook-like structure, and each of the two side regions of the step-like connecting portion abuts a corresponding one of the two side surfaces of the hook-like structure.

[0008] Another object of the present invention is to provide an endoscope treatment device for ligating living tissue, including a clip unit including a first arm portion, a second arm portion, and a tubular member capable of housing the first arm portion and the second arm portion so that the distal end of the first arm portion and the distal end of the second arm portion are close to each other; a wire member connected to the clip unit so that the clip unit advances and retreats; and a sheath into which the wire member is inserted so that the wire member can advance and retreat. The clip unit further includes an engagement structure provided inside the tubular member, including a step-like connecting portion and a hook-like structure, the engagement structure connecting a clip. The step-like connecting portion includes an engagement region connecting two side regions, the width of the engagement region of the step-like connecting portion being smaller than the width of a first side region of the two side regions of the step-like connecting portion. The hook-like structure includes two side surfaces connected by a hook surface. The surface of the engagement region of the step-like connecting portion engages the hook surface of the hook-like structure, and each of the two side regions of the step-like connecting portion abuts a corresponding one of the two side surfaces of the hook-like structure.

[0009] Further, the engagement structure can have variations. In one embodiment, the stepped connection portion is part of the clip, and the hook structure is connected to the operation wire. In another embodiment, the hook structure is part of the clip, and the stepped connection portion is connected to the operation wire. In still another embodiment, the engagement structure includes two hook structures each including two side surfaces connected by a hook surface, and the stepped connection portion includes surfaces associated with the two stepped connection portions, respectively, each of the stepped connection portions including an engagement region and two side regions. As a corresponding feature in one embodiment, the various features of the hook structure and the stepped connection portion function similarly.

[0010] Further, the present application also provides a clip device including a clip including two arm portions and an intermediate portion connecting the two arm portions at proximal ends thereof, and a connection portion connecting an operation wire to the intermediate portion, the clip device being characterized in that an engagement portion engaging the intermediate portion is provided at a distal end of the connection portion, and an abutment portion is provided so as to extend from the engagement portion to a position laterally of the arm portions and abut against the arm portions in a state in which the engagement portion engages the intermediate portion, and a portion of the connection portion in which the abutment portion is formed has a width greater than a width of other portions of the connection portion.

[0011] Further, the intermediate portion is a pin.

[0012] Further, as one embodiment of the clip device, the engagement portion is a hook claw engaging the intermediate portion. The abutment portion extends from the hook claw.

[0013] Further, the abutment portion can be provided continuously or discontinuously. In the case in which the abutment portion is provided discontinuously, the abutment portion is formed at least in a region from a root of the hook claw to a distal end of the hook claw in a length axis direction of the connection portion. Alternatively, the abutment portion extends radially from the hook claw in a plurality of directions.

[0014] Further, in the clip device, a thickness of the abutment portion can be the same as a thickness of the hook claw, or greater than the thickness of the hook claw.

[0015] Further, as another embodiment of the clamping device, the engagement portion includes two opposing engagement claws. A housing portion that houses the intermediate member and a notch are formed between the two engagement claws, the gap between the two engagement claws at the notch is smaller than the outer diameter of the intermediate member, and the intermediate member can be pushed into the housing portion via the notch. Thus, the intermediate member can be inserted between the two engagement claws. In a state where the intermediate member is inserted between the two engagement claws, if the intermediate member is pulled out from between the two engagement claws, the two engagement claws are deformed, and the intermediate member is separated from between the two engagement claws.

[0016] Further, in the clamping device, the abutting portion extends from the edge of the engagement claw. The abutting portion is continuously or discontinuously provided. In the case where the abutting portion is discontinuously provided, the abutting portion extends from the edge of the engagement claw, for example, in a radial manner.

[0017] Hereinafter, features and advantageous effects of the present application will be described, which can be partially clear from the description, or can be known by practicing the present application. The purposes of the endoscope treatment device and the clip unit of the present application and other advantageous effects can be achieved and obtained by the technical means specifically described in the specification, the scope of protection, and the drawings. BRIEF DESCRIPTION OF DRAWINGS

[0018] Figure 1 is a schematic cross-sectional view (part of the side of the endoscope treatment device is cut off) of an endoscope treatment device employing the clip unit of the first embodiment.

[0019] Figure 2 is a schematic cross-sectional view (part of the side of the endoscope treatment device is cut off) of an endoscope treatment device employing the clip unit of the first embodiment. Figure 1

[0020] Figure 3 is a side cross-sectional view of the clip unit in Figure 1

[0021] Figure 4 is a side cross-sectional view of the proximal end of the endoscope treatment device in Figure 1

[0022] Figure 5 is a top cross-sectional view of the proximal end of the endoscope treatment device in Figure 1

[0023] Figure 6 is a schematic perspective view taken along the cutting line A1-A1 in Figure 3

[0024] Figure 7 is a schematic perspective view taken along the cutting line A1-A1 in Figure 1 ​​​​​A schematic view of a state of the middle clamp unit.

[0025] Figure 8 is a view taken along Figure 4 cutting line A2-A2.

[0026] Figure 9A is an enlarged side view showing a configuration example of an embodiment of the joint structure between the clamp and the connecting member, Figure 9B is a schematic cross-sectional view taken along Figure 9A A3-A3 line in

[0027] Figure 10A is a schematic perspective view showing another configuration example of the joint structure between the clamp and the connecting member, Figure 10B is an enlarged view of the region E in Figure 10A Figure 10C is a schematic cross-sectional view showing the joint structure between the clamp and the connecting member in Figure 10A Figure 10D is a schematic side view showing the joint structure.

[0028] Figure 11A is a schematic perspective view showing the clamp and the connecting member of another embodiment, Figure 11B is a side view of Figure 11A Figure 11C is a schematic cross-sectional view showing the joint structure between the clamp and the connecting member in Figure 11A Figure 11D is a schematic side view showing the joint structure.

[0029] Figure 12 is a schematic view showing an example of use of the endoscope treatment device in Figure 1

[0030] is a schematic view showing the force required to pull back the slider with respect to the amount of movement of the slider being pulled back in the endoscope treatment device shown in Figure 13 Figure 1 is a schematic side cross-sectional view of the endoscope treatment device showing the clamp unit in

[0031] Figure 14 Figure 1 is a schematic plan cross-sectional view of the endoscope treatment device showing the clamp unit in

[0032] Figure 15 is a schematic plan cross-sectional view of the endoscope treatment device showing the clamp unit in Figure 1

[0033] is a schematic side cross-sectional view of the endoscope treatment device showing the clamp unit in Figure 16 Figure 1 is a schematic plan cross-sectional view of the endoscope treatment device showing the clamp unit in​​​​​​​

[0034] Figure 17 is a schematic plan cross-sectional view of the treatment device for an endoscope in the clamping unit of the Figure 1 is in the spanning state.

[0035] Figure 18 is a schematic view of the clamping unit of the Figure 1 in the spanning state from the proximal side.

[0036] Figure 19 is a schematic side cross-sectional view of the treatment device for an endoscope in the clamping unit of the Figure 1 is in the locked state.

[0037] Figure 20 is a schematic plan cross-sectional view of the treatment device for an endoscope in the clamping unit of the Figure 1 is in the locked state.

[0038] Figure 21 is a schematic view of the clamping unit of the Figure 1 in the locked state from the proximal side.

[0039] Figure 22 is a schematic view of another use example of the treatment device for an endoscope in the Figure 1 .

[0040] Figure 23 is a schematic view of another use example of the treatment device for an endoscope in the Figure 1 .

[0041] Figure 24 is a cross-sectional view of the vicinity of the clamping unit of the clamping device of the fourth embodiment.

[0042] Figure 25 is a schematic view of the pressing tube of the clamping device of the fourth embodiment.

[0043] Figure 26 is a schematic view of the connection relationship between the connection member and the arm portion of the clamping device of the fourth embodiment.

[0044] Figure 27 is a side view of the connection member of the clamping device of the fourth embodiment.

[0045] Figure 28 is a plan view of the abutting portion of the fourth embodiment, which is a deformation example in which the thickness is greater than the deformation of the hook claw, from the S direction of the Figure 27 .

[0046] Figure 29 is a side view of another deformation example of the connection member of the clamping device of the fourth embodiment.

[0047] Figure 30is a side view showing a connecting member of the clamping device of the fifth embodiment.

[0048] Figure 31 is a modification of the abutting portion whose thickness is greater than the deformation of the hook claw from Figure 27 is a plan view as viewed in the direction of S' of DETAILED DESCRIPTION

[0049] Hereinafter, the gist of the present application will be described with reference to the accompanying drawings, in conjunction with the foregoing summary and the following detailed description of the embodiments. In order to make clear the description, the proportions of the thicknesses or sizes of the respective constituent members are appropriately adjusted in the drawings.

[0050] Further, it should be noted that, in the specification, the "distal" end side refers to the direction away from the operation portion 100, and the "proximal" end side refers to the direction toward the operation portion 100. Figure 1

[0051] Figure 1 and Figure 2 is an endoscope treatment device 1 as a ligation tool, including a clip unit (hereinafter simply referred to as "clip") 10 and a treatment device main body 40. The clip 10 is detachably attached to the distal end of the treatment device main body 40. Figure 1 and Figure 2 is a cross-sectional view taken through the axis C1 of the pressure tube 31 described later.

[0052] Figure 3 is a cross-sectional view showing the clip 10 of the endoscope treatment device 1. Figure 4 is a cross-sectional view showing the proximal end of the endoscope treatment device 1. Figure 5 is also a cross-sectional view of the proximal end of the endoscope treatment device 1. Hereinafter, the configuration and operation will be described with reference to the schematic drawings, and the main parts will be described with reference to the detailed drawings.

[0053] Configuration: Arm portions 12, 13 of the clip 10

[0054] As shown in Figure 1 and Figure 2 , the clip 10 includes a clip main body 11, a pressure tube 31, and a coil spring (elastic member) 36. The pressure tube 31 is cylindrical, but can also be other tubular shapes, including shapes in which the cross-sectional shape is elliptical or a polygon having N sides (N can be greater than or equal to 4). The pressure tube 31 has an inner cavity and at least one open end to accommodate the proximal end of the clip main body 11 inserted therein. The coil spring 36 is accommodated within the pressure tube 31. The components that make up the clip 10, including the clip main body 11, are formed of a material such as cobalt-chromium alloy, titanium, or stainless steel. The clip 10 is capable of being observed under MRI (Magnetic Resonance Imaging) detection. ​

[0055] The jig body 11 includes a first arm portion 12, a second arm portion 13, and an intermediate portion 14. The first arm portion 12 and the second arm portion 13 extend from the proximal side of the jig body 11 toward the distal side, opposite to each other. The intermediate portion 14 is located between the proximal end of the first arm portion 12 and the proximal end of the second arm portion 13, as a connecting portion connecting the first arm portion 12 and the second arm portion 13. Further, the jig body 11 is configured to slide between a retracted position and a deployed position. The retracted position is located, for example, on the proximal side of the pressure tube 31, and when the jig body 11 is in the retracted position, the arm portions 12, 13 are in the inner cavity of the pressure tube 31. The deployed position is located, for example, on the distal side of the pressure tube 31, and when the jig body 11 is in the deployed position, the arm portions 12, 13 protrude from the open end of the pressure tube 31.

[0056] In the natural state, the first arm portion 12 and the second arm portion 13 are separated from each other from the proximal side toward the distal side. A claw portion 12a is formed at the distal end of the first arm portion 12, extending toward the second arm portion 13 side. A claw portion 13a is formed at the distal end of the second arm portion 13, extending toward the first arm portion 12 side.

[0057] Figure 6 is a schematic perspective view taken along the cutting line A1-A1 in Figure 3 As shown in Figure 6 , in the second arm portion 13, the cross-sectional shape orthogonal to the length direction on the distal side of the second arm portion 13 is in a circular arc shape. More specifically, in the following orthogonal direction Z, the intermediate portion of the outer surface of the arm portion 13 is in a curved surface shape protruding toward the outside. The arm portion 12 has a similar shape.

[0058] Therefore, for the first arm portion 12 and the second arm portion 13, the bending strength is improved, and the frictional resistance with the sheath tube 50 described later is reduced, so that the advance and retreat operation can be performed more smoothly.

[0059] Configuration: first locking portions 16, 17 of the jig 10

[0060] Here, as shown in Figure 1 , the X, Y, Z axes are defined, in which the first arm portion 12 and the second arm portion 13 are opposite to each other in the X axis, the Y axis is parallel to the axis C1 of the pressure tube 31, and the Z axis is orthogonal to the X axis and the Y axis, respectively. As shown in Figure 2 , two first locking portions 16, 17 are provided at the proximal end portion of the first arm portion 12. In a reference surface S1 parallel to the axis (central axis) C1 of the pressure tube 31, the first locking portions 16, 17 protrude from the side surface of the first arm portion 12 along the Z axis. The first locking portions 16, 17 protrude in opposite directions.

[0061] Figure 2 is a view of the endoscope treatment device shown in Figure 1 , as viewed from a direction orthogonal to the reference surface S1. As shown inFigure 2 As shown, the first locking portions 16, 17 are linearly symmetrical with respect to the axis C1.

[0062] As shown, the proximal end face 16a of the first locking portion 16 is obliquely separated from the first arm portion 12 (central axis C1) toward the distal end side of the first locking portion 16. The distal end face 16b of the first locking portion 16 is orthogonal to the Y axis. The proximal end face 17a and the distal end face 17b of the first locking portion 17 are linearly symmetrical with respect to the proximal end face 16a and the distal end face 16b of the first locking portion 16, respectively, with respect to the axis C1. Figure 2 Configuration: protrusions 18, 19 of the jig 10

[0063] As shown, in the first arm portion 12, the two protrusions 18, 19 are located at a position more distal than the first locking portions 16, 17. The protrusions 18, 19 protrude from the side surface of the first arm portion 12 along the Z axis. The protrusions 18, 19 form linear symmetry with respect to the axis C1. The length of the protrusions 18, 19 protruding from the first arm portion 12 along the Z axis is greater than that of the first locking portions 16, 17 protruding from the first arm portion 12 along the Z axis.

[0064] Figure 1 As shown, in the first arm portion 12, the two protrusions 18, 19 are located at a position more distal than the first locking portions 16, 17. The protrusions 18, 19 protrude from the side surface of the first arm portion 12 along the Z axis. The protrusions 18, 19 form linear symmetry with respect to the axis C1. The length of the protrusions 18, 19 protruding from the first arm portion 12 along the Z axis is greater than that of the first locking portions 16, 17 protruding from the first arm portion 12 along the Z axis. Figure 2 Configuration: second arm portion 13 of the jig 13

[0065] As shown, the distal end of the second arm portion 13 is formed with a claw portion 13a extending toward the first arm portion 12 side. As with the first locking portions 16, 17 and the protrusions 18, 19 of the first arm portion 12, the second arm portion 13 is formed with second locking portions 21, 22 and protrusions 23, 24, respectively. The second locking portions 21, 22 are shown in

[0066] , and the protrusions 23, 24 are not shown. That is, the second locking portions 21, 22 protrude from the side surface of the second arm portion 13 along the Z axis. The protrusions 23, 24 protrude from the side surface of the second arm portion 13 along the Z axis. In the second arm portion 13, the protrusions 23, 24 are located at a position more distal than the second locking portions 21, 22. Along the Z axis, the second locking portions 21, 22 and the protrusions 23, 24 are parallel to the first locking portions 16, 17 and the protrusions 18, 19, respectively. That is, in Figure 1 , the first locking portions 16, 17 overlap the second locking portions 21, 22, and the protrusions 18, 19 overlap the protrusions 23, 24. Figure 7 Figure 2 In the side view shown in , the first arm portion 12 and the second arm portion 13 are formed at positions linearly symmetrical with respect to the axis C1.

[0067] Figure 1

[0068] ​​​To manufacture the jig body 11, a plate material formed of a material such as a cobalt-chromium alloy is subjected to blanking processing so that the first arm portion 12, the second arm portion 13, the intermediate portion 14, the first locked portions 16, 17, the second locked portions 21, 22, and the protruding portions 18, 19, 23, 24 extend in a planar shape. Then, the connecting portions of the first arm portion 12 and the intermediate portion 14 and the connecting portions of the second arm portion 13 and the intermediate portion 14 are bent so that the blanked component as a whole has a C shape in a side view.

[0069] Configuration: connecting member 63

[0070] The connecting member 63 includes a hook-shaped structure 77 at a distal end of the bridge portion 76 and a through-hole 76a formed at a proximal end of the bridge portion 76. With reference to Figure 2 , a surface 76b is formed so as to face a hook surface of the hook-shaped structure 77. The surface 76b can be a surface inclined with respect to the axis C1 as shown in Figure 2 , or can be a surface extending upward in a direction orthogonal to the axis C1 as shown in Figure 9A .

[0071] When the bent portion of the wire 73a of the ring-shaped portion 73 is inserted into the through-hole 76a, the connecting member 63 is connected to the ring-shaped portion 73 so as to be rotatable about an axis parallel to the X axis (rotatable in the direction of the arrow in Figure 2 .

[0072] When the hook-shaped structure 77 is provided at the distal end side of the bridge portion 76, the width of the connecting member 63 is the outer diameter of the bridge portion 76 in the direction orthogonal to the central axis C1. The width of the connecting member 63 is slightly smaller than the inner diameter of the helical spring 36, the inner diameter of the coil sheath 66, and the inner diameter of the distal member 67.

[0073] By placing the intermediate portion 14 between the hook-shaped structure 77 of the connecting member 63 and the surface 76b of the connecting member 63, the hook-shaped structure 77 is able to engage with the intermediate portion 14.

[0074] Configuration: engagement portion between the jig 10 and the connecting member 63

[0075] First embodiment

[0076] Figure 9A is an enlarged side view for illustrating an example of the engagement configuration between the jig 10 and the connecting member 63, Figure 9B is a cross-sectional view taken along the A3-A3 line of Figure 9A . As shown in Figure 9A , the engagement configuration includes the hook-shaped structure 77 and the engagement portion 15 (also referred to as a stepped connecting portion). The stepped connecting portion 15 includes an engagement region ER and two side regions SR, and the engagement region ER is engaged with the hook surface 79 of the hook-shaped structure 77 (see Figure 10BThe two lateral regions SR are adjacent to the two side surfaces 78 of the hook structure 77. The two side surfaces 78 and the hook surface 79 are located at the distal end of the hook structure 77. The bridging portion 76 includes a first end connected to the distal end of the hook structure 77 and extends from the first end to form part of the recess RR of the connecting member 63. The engagement region ER is located in the middle portion 14 of the clamp 10, and the two lateral regions SR are located at the proximal ends of the first arm portion 12 and the second arm portion 13 of the clamp 10.

[0077] The joint region ER is along the Z-axis and with Figure 2 The two lateral regions SR, located on the first arm 12 and the second arm 13 respectively, have a width W1 in a direction orthogonal to the axis C1, along the Z-axis and perpendicular to the axis C1. Figure 2 The bridging portion 76 of the connecting member 63 has a width W2 in a direction orthogonal to the axis C1, and is also along the Z-axis and with... Figure 2 The width W3 is located in a direction orthogonal to axis C1. The relationship between widths W1, W2, and W3 can be set as follows: Width W2 is greater than width W1, preferably 1.5 to 2 times the width W1. Width W1 can be set to be approximately equal to width W3. Furthermore, the two side regions SR can have a first width on the first arm 12 side and a second width on the second arm 13 side, the first width and the second width being different, i.e., the first width and the second width have different lengths. However, width W1 is less than either the first width or the second width of the two side regions SR. That is, both the first width and the second width are greater than width W1, preferably 1.5 to 2 times the width W1.

[0078] The stepped connecting portion 15 also includes a first bottom surface 80 and a second bottom surface 81. The first bottom surface 80 may be part of the bottom surface of the intermediate portion 14, and the second bottom surface 81 may be part of the proximal surface of the first arm portion 12. The stepped connecting portion 15 has an angle α formed by the first bottom surface 80 and the second bottom surface 81. The angle α may be a right angle or an obtuse angle (greater than 90 degrees and less than 180 degrees). The first bottom surface 80 may be located above the top surface 76c of the bridging portion 76, or in contact with the top surface 76c of the bridging portion 76.

[0079] Although not shown, the stepped connecting portion formed by the second arm 13 and the intermediate portion 14 has the same structure as the stepped connecting portion 15. This stepped connecting portion also includes a region where the intermediate portion 14 contacts the hook structure 77 and other regions where the second arm 13 is adjacent to the hook structure 77. These two types of regions may have the same structure as the joining region ER and the two side regions SR, respectively. The stepped connecting portion may also include two bottom surfaces having the same structure as the aforementioned first bottom surface 80 and second bottom surface 81. One of the two bottom surfaces may be part of the proximal surface of the second arm 13, and the other bottom surface may be part of the bottom surface of the intermediate portion 14. The stepped connecting portion (not shown) may also have an α-angle formed by the two bottom surfaces, one of which may contact the top surface 76c of the bridging portion 76.

[0080] like Figure 13 As shown (and will be detailed later), when the clamp 10 is pulled forcefully towards the proximal side by the hook structure 77, the bridging portion 76, which connects to and supports the hook structure 77, must withstand the strong traction force from the operating portion 100. If the width W3 of the bridging portion 76 is too narrow relative to the width W1 of the engagement area ER, the strength of the connecting member 63 in its axial direction will weaken, causing deformation of the hook structure 77. As a result, due to this deformation, the first arm 12 and the second arm 13 of the clamp 10 may detach from the hook structure 77 before the claws 12a and 13a of the clamp 10 successfully clamp the target tissue. By increasing the width W3 to approximately the same extent as the width W1, the strength of the bridging portion 76 in the axial direction will be enhanced. Therefore, when the clamp 10 is pulled towards the proximal side by the hook structure 77, it is possible to prevent the clamp 10 from detaching from the connecting member 63 before the clamping operation is completed.

[0081] On the other hand, by rotating the hook-shaped structure 77 about the axial direction of the connecting member 63, the clamp 10 can rotate inside the pressure tube 31. To prevent the first arm 12 and the second arm 13 from detaching from the hook-shaped structure 77 inside the pressure tube 31 during rotation, it is necessary to strengthen the connection structure between the clamp 10 and the connecting member 63 in the rotational direction. In this embodiment, by setting the width W2 to be greater than the width W1, preferably 1.5 to 2 times the width W1, the area between the first arm 12, the second arm 13, and the hook-shaped structure 77 is larger than the contact area. Figure 9B As shown, in the side view viewed from the Y-axis, except for the top 77a of the hook-shaped structure 77, the first arm 12 and the second arm 13 overlap with the entire side 78 of the hook-shaped structure 77. According to this embodiment, by providing a larger contact area, the strength of the connection structure in the rotational direction is enhanced. Therefore, when the connecting member 63 is rotated, the clamp 10 is prevented from disengaging from the connecting member 63 before the clamping operation is completed.

[0082] Second embodiment

[0083] Figure 10A is a perspective view schematically illustrating the jig 10' and the connecting member 63' of the second embodiment, Figure 10B is Figure 10A is an enlarged view of the region E. As Figure 10A and Figure 10B illustrated, the second embodiment differs from the first embodiment in that the engagement configuration of the second embodiment includes first and second hook-shaped structures 77a, 77b and first and second step-shaped connecting portions 15a, 15b. In the present embodiment, each of the first and second hook-shaped structures can be identical to the hook-shaped structure 77 in the first embodiment. That is, the first hook-shaped structure 77a includes two side surfaces 78 connected by a hook surface 79, and the second hook-shaped structure 77b includes two side surfaces 78 connected by a hook surface 79. Further, each of the first and second step-shaped connecting portions 15a, 15b can be identical to the step-shaped connecting portion 15 in the first embodiment. That is, the first step-shaped connecting portion 15a includes an engagement region ER and side regions SR, and the second step-shaped connecting portion 15b includes an engagement region ER and side regions SR. As a result, the engagement region of the first step-shaped connecting portion engages with the hook surface of the first hook-shaped structure, and each of the two side regions of the first step-shaped connecting portion abuts against a corresponding one of the two side surfaces of the first hook-shaped structure. The engagement region of the second step-shaped connecting portion engages with the hook surface of the second hook-shaped structure, and each of the two side regions of the second step-shaped connecting portion abuts against a corresponding one of the two side surfaces of the second hook-shaped structure. However, the first and second hook-shaped structures 77a, 77b can have structures different from each other, and the first and second step-shaped connecting portions 15a, 15b can have structures different from each other.

[0084] Further, in the engagement configuration of the second embodiment, the first and second step-shaped connecting portions 15a, 15b are formed at the proximal ends of the first and second arm portions 12', 13', respectively, and the first and second hook-shaped structures 77a, 77b are formed at the distal end of the connecting member 63'. The first and second step-shaped connecting portions 15a, 15b are linearly symmetrical with respect to the axis CI in a side view, the first and second hook-shaped structures 77a, 77b are linearly symmetrical with respect to the axis CI in a side view, and the two corresponding bridge portions 76a, 76b are linearly symmetrical with respect to the axis CI in a side view.

[0085] In the present embodiment, the width relationships between the first and second step-shaped connecting portions 15a, 15b and the bridge portions 76a, 76b are identical to those of the first embodiment.

[0086] Figure 10C is a cross-sectional view schematically illustrating the engagement configuration of the jig 10' and the connecting member 63',Figure 10D is another schematic cross-sectional view showing the engagement configuration of the clamp 10' and the connecting member 63'. Compared with the first embodiment, the second embodiment employs a double-step-shaped connecting portion and a double-hook-shaped structure, providing a more stable engagement between the clamp 10' and the connecting member 63'.

[0087] Third Embodiment

[0088] Figure 11A is a perspective view schematically showing the clamp 10" and the connecting member 63" of the third embodiment, Figure 11B is a schematic cross-sectional view of Figure 11A . As shown in Figure 11A , Figure 11B the third embodiment differs from the first embodiment in that the engagement configuration has a hook-shaped structure 77" extending from (integrally formed with) the first and second arm portions 12", 13" and a connecting member 63" hooking the hook-shaped structure 77". The connecting member 63" has a step-shaped connecting portion 15" formed by two arms 81, 82 and an intermediate portion 83. The intermediate portion 83 can be regarded as a connecting portion connecting the arms 81, 82. Thus, in the third embodiment, the connecting member 63" having the step-shaped connecting portion 15" is added to the hook-shaped structure 77" on the clamp 10".

[0089] The hook-shaped structure 77" is attached to the clamp 10" by means such as welding.

[0090] Figure 11C is a cross-sectional view schematically showing the engagement configuration between the clamp 10" and the connecting member 63", Figure 11D is another schematic cross-sectional view showing the engagement between the clamp 10" and the connecting member 63". The difference from the first embodiment is that, in the third embodiment, the hook-shaped structure 77" is a part of the clamp 10" and formed at the proximal end (connecting portion 14) of the clamp 10", and the step-shaped connecting portion 15" is a part of the connecting member 63" and located at the distal end of the connecting member 63". The proximal end of the connecting member 63" is connected to the linear member 74 (refer to Figure 1 ).

[0091] Configuration: Locking portion 32 of clamp 10

[0092] As shown in Figure 2 and Figure 7 , the locking portion 32 projects along the entire inner peripheral surface at the proximal end of the pressing tube 31. When viewed in the Y-axis direction in Figure 7 , the edge 32a of the locking portion 32 on the axis C1 side forms a ring coaxial with the pressing tube 31. As shown in Figure 2As shown, the proximal end surface 32b (proximal side surface) and the distal end surface 32c (distal side surface) of the locking portion 32 are orthogonal to the Y-axis.

[0093] The portion of the first arm portion 12 closer to the end side than the protrusions 18, 19, the portion of the second arm portion 13 closer to the end side than the protrusions 23, 24, and the intermediate portion are capable of being inserted into the locking portion 32. As shown in FIG. 2, the protrusions 18, 19, 23, 24 are capable of being inserted into the locking portion 32. Figure 7 As shown, the length LI along the Z-axis between the end of the first locked portion 16 and the end of the first locked portion 17 is smaller than the inner diameter of the locking portion 32. In the initial state described later, the portions of the first locked portions 16, 17 overlap the locking portion 32 when viewed along the Y-axis. That is, in the state shown in FIG. 2, the first locked portions 16, 17 are positioned at positions P1, P2, and the edge 32a is set such that the length LI between the first locked portions 16, 17 is greater than the height of the edge 32a at that position (the length of the line segment between the positions P1, P2). Figure 7 As shown, the first locked portions 16, 17 are positioned at positions P1, P2 with respect to the edge 32a, which is set such that the length LI between the first locked portions 16, 17 is greater than the height of the edge 32a at that position (the length of the line segment between the positions P1, P2).

[0094] As shown, the tapered surface 31a is formed on the entire inner peripheral surface of the distal end of the press pipe 31. The diameter of the tapered surface 31a expands toward the distal end side of the press pipe. Figure 2

[0095] The press pipe 31 and the locking portion 32 are integrally formed of a material such as 64 titanium alloy (Ti-6Al-4V) or cobalt-chromium alloy.

[0096] Configuration: end winding portion 36b of the coil spring 36 of the clamp 10

[0097] As shown, the distal end of the coil spring 36 is provided with an end winding portion 36b. The inner diameter of the end winding portion 36b formed is smaller than the other portions of the coil spring 36. Figure 3 When the coil spring 36 is housed inside the press pipe 31, the distal end of the coil spring 36 is connected to the protrusions 18, 19, 23, 24, and the proximal end of the coil spring 36 is connected to the locking portion 32. The proximal end of the coil spring 36 and the locking portion 32 can be fixed by a method such as welding.

[0098] The portion of the first arm portion 12 closer to the end side than the protrusions 18, 19, the portion of the second arm portion 13 closer to the end side than the protrusions 23, 24, and the intermediate portion 14 are capable of being inserted into the coil spring 36. When the protrusions 18, 19, 23, 24 move toward the proximal end side, the protrusions 18, 19, 23, 24 are connected to the end winding portion 36b of the coil spring 36. Even if the coil spring 36 does not include the end winding portion 36b, the same good effect can be obtained by using a separate component such as a washer at the distal end of the coil spring 36.

[0099] As shown, the tapered surface 31a is formed on the entire inner peripheral surface of the distal end of the press pipe 31. The diameter of the tapered surface 31a expands toward the distal end side of the press pipe.

[0100] Figure 1 and​​Figure 2 In the initial state of the clamp 10 shown, the proximal end of the first arm portion 12, the proximal end of the second arm portion 13, and the intermediate portion 14 are located on the distal end side with respect to the locking portion 32 inside the pressure tube 31. The first locked portions 16, 17 and the second locked portions 21, 22 are not in contact with the locking portion 32 of the pressure tube 31. The winding 36a of the adjacent spiral spring 36 in the Y-axis direction is separated from each other. The spiral spring 36 is slightly compressed in the Y-axis direction compared to the natural state. In the clamp main body 11, the distal end of the first arm portion 12 and the distal end of the second arm portion 13 are separated from each other, and are in an open state.

[0101] Configuration: relationship between the clamp main body 11 of the clamp 10 and the pressure tube 31

[0102] In the clamp 10 described above, the first arm portion 12 and the second arm portion 13 are separated from each other in the X-axis direction in the initial state. Therefore, as Figure 7 shown, when the first locked portion 16 is viewed from the proximal end side, the first locked portion 16 overlaps with a portion of the edge 32a at a position P1 of the locking portion 32. That is, when the first arm portion 12 moves toward the proximal end side with respect to the pressure tube 31, the first locked portion 16 comes into contact with a portion of the edge 32a at the position P1. The portion of the edge 32a at the position P1 is in point contact with the first locked portion 16.

[0103] Likewise, when the first arm portion 12 moves toward the proximal end side with respect to the pressure tube 31, the first locked portion 17 comes into contact with a portion of the edge 32a at a position P2. The portion of the edge 32a at the position P2 is in point contact with the first locked portion 17. The proximal end face 16a of the first locked portion 16 comes into contact with a portion of the edge 32a at the position P1. The proximal end face 17a of the first locked portion 17 comes into contact with a portion of the edge 32a at the position P2.

[0104] The positions on the edge 32a corresponding to the positions P1, P2 are denoted as Q1, Q2 in Figure 2 .

[0105] Likewise with the first locked portions 16, 17 of the first arm portion 12, when the second arm portion 13 formed integrally with the first arm portion 12 moves toward the proximal end side with respect to the pressure tube 31, the second locked portions 21, 22 come into contact with the locking portion 32 of the pressure tube 31.

[0106] Configuration: treatment device main body 40

[0107] Next, the treatment device main body 40 will be described.

[0108] As Figure 1 , Figure 2As shown, the treatment device main body 40 includes a sheath tube 50, an insertion section 60, and an operation section 100. The insertion section 60 is retractably inserted into the sheath tube 50. The operation section 100 is connected to the proximal end of the insertion section 60.

[0109] The sheath tube 50 can be formed of a fluorine resin such as polytetrafluoroethylene (PTFE), for example, or a resin material such as high-density polyethylene (HDPE).

[0110] Configuration: sheath section 61 of treatment device main body 40

[0111] The insertion section 60 includes a sheath section 61 and an operation wire 62. The operation wire 62 is retractably inserted into the sheath section 61. A connection member 63 is connected to the distal end of the operation wire 62. The connection member 63 is rotatable about an axis parallel to the X axis with respect to the operation wire 62.

[0112] The sheath section 61 includes a coil sheath 66 and a distal member (stopper) 67 fixed to the distal end of the coil sheath 66. The coil sheath 66 is made of, for example, stainless steel such as JIS (Japanese Industrial Standards) SU301 having high compression resistance.

[0113] A coil densely wound (not shown) along the Y axis can be used for the coil sheath 66. The coil sheath 66 has flexibility and has high compression resistance in the Y axis. The inner diameter of the coil sheath 66 is substantially identical to the inner diameter of the coil spring 36.

[0114] The distal member 67 is formed in a cylindrical shape of, for example, stainless steel. The inner diameter of the distal member 67 is smaller than the inner diameter of the coil sheath 66. The outer diameter of the distal member 67 is larger than the outer diameter of the coil sheath 66 or the compression tube 31. By reducing the outer diameter, a recessed portion 67a is formed in the outer peripheral surface of the proximal end of the distal member 67. After the distal end of the coil sheath 66 is fitted into the recessed portion 67a, the distal member 67 and the coil sheath 66 are fixed by laser welding or the like.

[0115] In the inner peripheral surface of the distal end of the sheath section 61, a stepped portion 68 is formed in the connection portion of the coil sheath 66 and the distal member 67 by reducing the inner diameter of the distal member 67 located on the distal end side from the inner diameter of the coil sheath 66. The inner diameter of the distal member 67 is set so that the distal member 67 does not engage with the first locked portions 16, 17 and the second locked portions 21, 22 when the jig 10 is engaged with the lock portion 32. This will be described later.

[0116] Configuration: distal member 67 of treatment device main body 40

[0117] A recess is formed in the entire inner peripheral surface of the distal end member 67 at the distal end thereof, and a support portion 69 is provided at a position distal to the recess. In the present embodiment, the support portion 69 is formed in a cylindrical shape. The support portion 69 has an inner diameter slightly larger than the outer diameter of the pressure tube 31, and is sized to accommodate the proximal end of the pressure tube 31. In the recess of the inner peripheral surface of the support portion 69, the surface facing forward is a distal end support surface (distal end surface) 67b. The distal end support surface 67b is capable of coming into contact with the proximal end surface of the pressure tube 31. The jig 10 is provided at the distal end side of the sheath portion 61. The support portion 69 is capable of supporting the outer peripheral surface of the pressure tube 31 that comes into contact with the distal end support surface 67b.

[0118] In such a configuration, the jig 10 is capable of being restrained from shaking with respect to the support portion 69 as much as possible, so a certain degree of inclination of the jig 10 with respect to the support portion 69 is allowed. Therefore, the endoscope treatment device 1 is capable of being smoothly inserted into a curved shape endoscope forceps channel or the like.

[0119] Configuration: Operating wire 62 of treatment device body 40

[0120] The operating wire 62 is made of, for example, a metal single wire or a metal stranded wire. The ring-shaped portion 73 is provided at the distal end of the operating wire 62 via the enlarged diameter portion 72. The linear member 74 (refer to Figure 1 ) is formed of the operating wire 62 and the ring-shaped portion 73.

[0121] The enlarged diameter portion 72 is formed in a cylindrical shape from a material such as metal. The outer diameter of the enlarged diameter portion 72 is smaller than the inner diameter of the coil sheath 66, and is larger than the inner diameter of the distal end member 67. When the distal end surface of the enlarged diameter portion 72 comes into contact with the step portion 68, the amount of protrusion of the ring-shaped portion 73 with respect to the sheath portion 61 is limited to a length L2 (refer to Figure 22 ). The length L2 is the maximum amount of protrusion of the ring-shaped portion 73 allowed by the distal end member 67.

[0122] The ring-shaped portion 73 is formed by turning over the wire material 73a. The wire material 73a is turned over with the turned portion being located at the distal end side of the wire material 73a. The both ends of the wire material 73a are fixed to the enlarged diameter portion 72 by, for example, brazing, welding, or the like.

[0123] Configuration: Operating portion 100 of treatment device body 40

[0124] As shown in Figure 1 , the operating portion 100 includes an operating portion body 101, a slider 102, and the breakage structure 64. The operating portion body 101 is attached to the proximal end of the coil sheath 66. The slider 102 is externally fitted to the operating portion body 101, and is capable of sliding with respect to the operating portion body 101 along the Y axis. The breakage structure 64 is connected to the proximal end of the operating wire 62 and the slider 102.

[0125] The operation portion main body 101 is formed in a rod shape extending along the Y axis. The hook finger portion 101a is connected to the proximal end of the operation portion main body 101. A flat surface portion 101c is provided on the proximal end side of the hook finger portion 101a, enabling the operation portion 100 to be easily held by both hands (see Figure 4 ). The operation portion main body 101 is formed with a slit 101b extending along the Y axis.

[0126] The slider 102 is formed in a cylindrical shape. A recessed portion 102a is formed on the outer circumferential surface of the slider 102 in the circumferential direction. On the Y axis, a pair of flange portions 102b, 102c are formed on the slider 102, with the recessed portion 102a positioned between the pair of flange portions 102b, 102c. The pair of flange portions 102b, 102c have an elliptical shape when viewed from the Y axis direction (see Figure 4 and Figure 8 ). Thus, the slider 102 can be easily held. When the operation portion 100 of the endoscope treatment device 1 is packaged, space can be saved. As shown in Figure 5 , a groove 102e extending in the Z axis direction is formed in the tube hole 102d of the slider 102.

[0127] When the slider 102 is engaged with the slit 101b of the operation portion main body 101, the movement range of the slider 102 relative to the operation portion main body 101 in the Y axis direction is limited. As shown in Figure 4 and Figure 5 , a break structure 64 is provided in the tube hole 102 of the slider 102. That is, the break structure 64 is provided in the operation portion 100.

[0128] Operation of the treatment device main body 40

[0129] Next, the operation of the treatment device main body 40 will be described.

[0130] In the foregoing configuration, by sliding the slider 102 relative to the operation portion main body 101 in the Y axis direction, the operation wire 62 can be advanced and retracted in the Y axis direction, thereby enabling the clamp 10 to be advanced and retracted relative to the pressing tube 31.

[0131] Action: Initial state

[0132] Next, the operation of the clamp 10 of the endoscope treatment device 1 using the foregoing configuration to ligate a target tissue will be described.

[0133] As Figure 12As shown, when the endoscope treatment device 1 is provided to a user (operator) for use, the sheath tube 50 is pushed to the insertion section 60, and the clamp 10 mounted on the treatment device main body 40 is covered. The coil spring 36 of the clamp 10 in the initial state is slightly compressed in the Y-axis direction compared to the natural state. Therefore, the proximal end surface of the pressing tube 31 comes into contact with the distal end support surface 67b. The distal end surface of the enlarged diameter section 72 comes into contact with the step section 68, and the ring section 73 protrudes from the distal end member 67 to the maximum protrusion amount.

[0134] When the endoscope treatment device is used, the insertion section of the endoscope is inserted into the body of a patient. The sheath tube 50 of the endoscope treatment device 1 is inserted from the proximal end of the endoscope channel and protrudes from the distal end of the endoscope channel. When the sheath tube 50 is pulled back with respect to the insertion section 60, the clamp 10 protrudes from the distal end side of the sheath tube 50, as shown. Figure 1 As a result, the first and second arm sections 12, 13 of the clamp 10 become the open state as shown. Figure 1

[0135] Figure 13 is a graph showing the force required to pull back the slider with respect to the movement amount of the slider being pulled back in the endoscope treatment device. From the initial state as shown, the slider 102 is moved (pulled back) toward the proximal end side with respect to the operation section main body 101. The clamp 10 is set so that the force required to pull back the slider changes with the movement as shown. Figure 1 Figure 13 is a graph showing the force required to pull back the slider with respect to the movement amount of the slider being pulled back in the endoscope treatment device. From the initial state as shown, the slider 102 is moved (pulled back) toward the proximal end side with respect to the operation section main body 101. The clamp 10 is set so that the force required to pull back the slider changes with the movement as shown. Figure 13 is a graph showing the relative change in the force required to pull back the slider in different states of the clamp 10, such as the initial state.

[0136] With the pull back operation of the slider 102, the state of the clamp 10 changes from the initial state to the contact state, the crossing state, and the locked state. Hereinafter, the change in the force and the change in the state of the clamp 10 are described.

[0137] In the initial state, for example, the enlarged diameter section 72 is in contact with the step section 68. Therefore, the proximal end surface of the pressing tube 31 is in contact with the distal end support surface 67b, and the pressing tube 31 and the distal end support surface 67b do not separate at least over the depth of the support section 69 in the length direction.

[0138] Next, when an in-vivo examination is performed using an endoscope, the clamp 10 is turned toward a target tissue T in the body by performing a bending operation on a bendable section provided to the insertion section of the endoscope (refer to Figure 16 ). By pushing out the endoscope treatment device 1 in the endoscope, the first and second arm sections 12, 13 come into abutment with the target tissue T.

[0139] ​​When the user pulls back the slider 102, the first arm portion 12 and the second arm portion 13 are pressed by the inner circumferential surface of the distal end of the compression tube 31. As a result, the first arm portion 12 is elastically deformed toward the second arm portion 13 side, and the second arm portion 13 is elastically deformed toward the first arm portion 12 side, whereby the distal end of the first arm portion 12 approaches the distal end of the second arm portion 13 (the first and second arm portions 12, 13 are closed). The coil spring 36 is gradually compressed in the Y-axis direction.

[0140] The force to pull back the slider 102 is transmitted to the breaking structure 64.

[0141] Action: from the initial state to the contact state

[0142] When the slider 102 is pulled back, as shown in Figure 7 , Figure 14 , Figure 15 the first and second locking portions 16, 17 and the second and third locking portions 21, 22 come into contact with the locking portion 32 of the compression tube 31. At this time, as shown in Figure 7 , the first locking portion 16 and the second locking portion 17 come into contact with the edge 32a of the compression tube 31 at positions PI and P2, respectively.

[0143] In the region Rl corresponding to the initial state to the contact state, as shown in Figure 13 , the force required to pull back the slider 102 increases as the slider 102 is pulled back. The clamp 10 changes from the open state to the closed state. Since the connecting member 63 is located inside the compression tube 31 or the sheath portion 61, the connecting member 63 does not rotate with respect to the annular portion 73, and the engagement of the hook structure 77 and the intermediate portion 14 is maintained. Since the breaking structure 64 has not yet broken, the force to pull back the slider 102 can be transmitted to the operation wire 62 via the breaking structure 64.

[0144] When the slider 102 is pushed out, the force to push out the slider 102 can be transmitted to the operation wire 62.

[0145] Action: from the contact state to the crossing state

[0146] As described above, the proximal end surfaces 16a, 17a of the first and second locking portions 16, 17 are inclined. The edge 32a of the locking portion 32 has a ring shape. Therefore, when the slider 102 is further pulled back, if the first locking portion 16 is viewed from the Y-axis direction in Figure 18 , the first locking portion 16 receives a vertical force from the edge 32a, which is parallel to the normal line N orthogonal to the tangent line θ of the edge 32a at PI, at which the first locking portion 16 comes into contact with the edge 32a of the locking portion 32. This vertical force moves the first locking portion 16 of the first arm portion 12 in the X-axis direction, and brings the first locking portion 16 closer to the second arm portion 13.

[0147] When the pulling operation continues, as shown in Figures 16-18 the first locked portions 16, 17 and the locking portion 32 become point contact, and the contact position of the edge 32a of the locking portion 32 with the first locked portion 16 moves from the position PI to a position P3. At the same time, the contact position of the edge 32a of the locking portion 32 with the first locked portion 17 moves from the position P2 to a position P4. Figures 16-18 The state in which the distal end of the proximal face 16a of the first locked portion 16 and the distal end of the proximal face 17a of the first locked portion 17 come into contact with the edge 32a of the locking portion 32 is referred to as the "crossing state".

[0148] Likewise, the second arm portion 13 is pressed by the vertical force from the edge 32a of the locking portion 32, and moves toward the first arm portion 12 in the X-axis direction. At this time, the intermediate portion 14 is elastically deformed, and the both ends of the intermediate portion 14 move toward the axis CI side.

[0149] In the initial state, the direction of the clamp 10 can be adjusted by rotating the operation wire 62 with respect to the sheath portion 61.

[0150] In the region R2 corresponding to the contact state to the crossing state, as shown in Figure 13 the ratio of the force required to pull back the slider 102 to the unit movement amount of the slider 102 being pulled back increases. That is, the ratio of the region R2 is larger than the aforementioned region Rl. In other words, the region Rl exhibits a relatively gentle gradient (slope) of the force change characteristic, whereas the region R2 exhibits a relatively steep gradient (slope) of the force change characteristic, in which the first locked portions 16, 17 and the second locked portions 21, 22 come into contact with the locking portion 32.

[0151] That is, when the user pulls back the slider 102, the user pulling back the slider 102 suddenly feels that it is more difficult to pull the slider 102 in the region R2 than in the region Rl. Thus, the user can easily recognize whether the state in which the user is currently pulling the slider 102 is in the region Rl or the region R2. In other words, the user can easily recognize whether the pulling back of the slider 102 has passed the contact state or not.

[0152] In the region R2, the closed state of the clamp 10 is maintained. Since the connecting member 63 is still in the sheath portion 61, the engagement of the hook structure 77 and the intermediate portion 14 is also maintained. The break structure 64 is not broken. For example, as shown in Figure 13 the force Fl required to cause the clamp 10 to enter the crossing state is approximately in the range of 20 N to 50 N.

[0153] As shown in Figure 18 in the crossing state, the distance between the position P3 and the position P4 of the edge 32a is the same as the length LI of the aforementioned first locked portions 16, 17.

[0154] Action: Re-gripping

[0155] The clamp 10 is elastically deformed. Therefore, if the slider 102 is pushed out while the clamp 10 is in either of the regions Rl, R2, the compressed coil spring 36 is stretched. When the pressing tube 32 comes into contact with the distal end support surface 67b, the clamp main body 11 moves toward the distal end side relative to the pressing tube 31, and the clamp 10 enters the initial state as shown. For example, by a bending operation of the bendable portion, the clamp 10 is turned toward another target tissue T. Then, the operation is performed in accordance with the aforementioned steps, and the target tissue T can be re-gripped by the clamp 10. Figure 1

[0156] Action: From the straddling state to the locked state

[0157] When the slider 102 is further pulled back from the straddling state, the positions of the first arm portion 12 and the second arm portion 13 relative to the pressing tube 31 in the X axis and the Z axis are maintained. In this state, the first arm portion 12 provided with the first locked portions 16, 17 and the second arm portion 13 provided with the second locked portions 21, 22 are inserted into the inside of the locking portion 32. Then, the first locked portions 16, 17 and the second locked portions 21, 22 move toward the proximal end side across the locking portion 32.

[0158] At this time, the first and second arm portions 12, 13 and the intermediate portion 14 are no longer subjected to the force from the locking portion 32. Therefore, as shown in Figs. 19 and 20, the proximal end side of the first arm portion 12 and the proximal end side of the second arm portion 13 are moved in the X axis by the elastic force of the intermediate portion 14 that separates the two arms from each other. When the force that moves the clamp main body 11 toward the proximal end side of the pressing tube 31 is removed, the distal end faces 16b, 17b of the first locked portions 16, 17 enter the locked state in which the distal end faces 16b, 17b are locked by the proximal end face 32b of the locking portion 32. That is, the distal end faces 16b, 17b are held on the distal end side of the proximal end face 32b. Figure 19 Figure 20 In the region R3 corresponding to the straddling state to the locked state, as shown in Figs. 21 and 22, the elastic deformation of the first and second arm portions 12, 13 and the intermediate portion 14 is partially released. Therefore, the force required to pull back the slider 102 gradually decreases as the slider 102 is pulled back. In the region R3, the closed state of the clamp 10 is maintained. Since the connecting member 63 is located inside the sheath portion 61, the engagement of the hook member 77 and the intermediate portion 14 is maintained. The break structure 64 is not broken.

[0159] In the region R3 corresponding to the straddling state to the locked state, as shown in Figs. 21 and 22, the elastic deformation of the first and second arm portions 12, 13 and the intermediate portion 14 is partially released. Therefore, the force required to pull back the slider 102 gradually decreases as the slider 102 is pulled back. In the region R3, the closed state of the clamp 10 is maintained. Since the connecting member 63 is located inside the sheath portion 61, the engagement of the hook member 77 and the intermediate portion 14 is maintained. The break structure 64 is not broken. Figure 13 When the clamp 10 enters the locked state, as shown in Figs. 23 and 24, the first and second arm portions 12, 13 and the intermediate portion 14 are in the locked state. The first and second arm portions 12, 13 are separated from each other by the elastic force of the intermediate portion 14. The first and second arm portions 12, 13 are locked by the locking portion 32. The first and second arm portions 12, 13 are held on the distal end side of the proximal end face 32b of the locking portion 32.

[0160] Figure 19 Figure 20 ​​​​As shown, the windings 36a of the helical spring 36 compressed in the Y-axis direction enter a closed winding state, that is, the windings 36a adjacent in the Y-axis direction almost come into contact with each other. When the clip 10 enters the locked state, the distal end faces 16b, 17b of the first locked portions 16, 17 lock with the proximal end face 32b of the locking portion 32. Thus, the movement of the clip main body 11 toward the distal end side with respect to the pressing tube 31 is restricted. That is, the state of the clip 10 ligating the target tissue T is maintained, and the clip 10 does not return to the initial state in which the first and second arm portions 12, 13 are open. The clip 10 is held in the state in which the first and second arm portions 12, 13 are closed. In the clip 10, the intermediate portion 14 protrudes from the proximal end side with respect to the pressing tube 31.

[0161] When the first and second locked portions 16, 17, 21, 22 move toward the proximal end side across the locking portion 32, the first and second locked portions 16, 17, 21, 22 can cross the locking portion 32 by abutting against the locking portion 32 to rub against the locking portion 32 or deform the locking portion 32. In the present embodiment, in order to avoid excessive damage to the locking portion 32, it is preferable to perform a process such as chamfering on the portions of the first and second locked portions 16, 17, 21, 22 that come into contact with the locking portion 32.

[0162] Action: Just before the broken state

[0163] Since the helical spring 36 is in the compressed state, even if the slider 102 is further pulled back, the clip main body 11 cannot move toward the proximal end side with respect to the pressing tube 31. The locked state of the clip 10 is maintained. However, as the slider 102 is pulled back, the tension acting on the breakable structure 64, the operation wire 62, and the like gradually increases. For example, in the region R3 shown in FIG. 9, the region R3 corresponds to the state just before the breakable structure 64 breaks from the locked state to the broken state, as shown in FIG. 10. Figure 13 In the region R4 shown in FIG. 9, the region R4 corresponds to the state just before the breakable structure 64 breaks from the locked state to the broken state, as shown in FIG. 10. Figure 13 As shown, the closed state of the clip 10 is maintained. Since the connecting member 63 is located inside the sheath portion 61, the engagement of the hook-like structure 77 and the intermediate portion 14 is maintained. The breakable member 82 of the breakable structure 64 does not break.

[0164] Action: Broken state

[0165] Further pulling back of the slider 102 causes the operation force of the slider 102 to reach a value greater than or equal to a predetermined value, and the tension acting on the breakable structure 64 exceeds the breaking strength of the breakable structure 64. At this time, the breakable structure 64 enters the broken state, and the breakable member in the breakable structure 64 breaks.

[0166] After the breakable component of the fracture structure 64 breaks, the fracture impact is transmitted to the user holding the operating part 100. When the breakable component of the fracture structure 64 breaks, the fracture structure 64 makes the user aware that the clamp 10 is fixed in the closed state. Because the fracture structure 64 is provided in the operating part 100, the user can more easily perceive the aforementioned impact.

[0167] When the user perceives the transmitted impact, the user is aware that the clamp 10 has entered the locked state and the ligation of the target tissue T will be maintained. Even if the user pulls the slider 102 further back, so that the slider 102 contacts the proximal end of the gap 101b of the operating part body 101, the user is aware that the clamp 10 is in the locked state.

[0168] Because the clamp 10 is locked, the operating line 62 will not move toward the proximal side.

[0169] Figure 13 The area R5 shown includes the fractured state and the state where the slider 102 is further pulled back after the clamp 10 is in the fractured state. Figure 13 In region R5, the fractured component of fracture structure 64 breaks, temporarily reducing the force required to pull back slider 102, which then increases as slider 102 is pulled back. In region R5, the closed state of clamp 10 is maintained. Because connecting member 63 is located inside sheath portion 61, the engagement between hook structure 77 and intermediate portion 14 is maintained. The fractured component of fracture structure 64 breaks.

[0170] Action: Separation of clamp 10

[0171] The separation of clamp 10 from the main body of the treatment device will now be explained.

[0172] The step of separating the clamp 10 from the main body of the disposal device is as follows. That is, when the slider 102 is pushed out, the operating line 62 moves toward the distal end relative to the coil sheath 66. Figure 22 As shown, the distal end face of the enlarged diameter portion 72 contacts the stepped portion 68, and the annular portion 73 extends out of the distal end member 67 by a length L2 as the maximum extension.

[0173] As the connecting member 63 extends distally relative to the distal member 67, the clamp body 11 and the pressure tube 31 move distally as a whole. Since the connecting member 63 is located outside the pressure tube 31, it can rotate relative to the annular portion 73. When the slider 102 is pushed out and the operating line 62 moves distally, the surface 76b of the connecting member 63 contacts the proximal end face of the middle portion 14 of the clamp 10, which is ligated with the target tissue T. Figure 23As shown, the hook structure 77 is guided to the surface 76b and rotated with the bridge 76 toward the D direction, whereby the engagement of the hook structure 77 and the intermediate portion 14 is released. Thus, the clip 10 ligation the target tissue T is left in the body.

[0174] That is, in the state represented by the region R5 to the state where the slider 102 is pushed out and the connecting member 63 is stretched toward the distal end side with respect to the distal end member 67, the closed state of the clip 10 is maintained, as shown in Figure 22 The engagement of the hook structure 77 and the intermediate portion 14 can be released. The breakable member of the break structure 64 has been broken.

[0175] Action: Last procedure of operation

[0176] The slider 102 is pulled back, and the connecting member 63 is housed inside the sheath portion 61.

[0177] The endoscope treatment device 1 is pulled out from the forceps channel of the endoscope. The insertion portion of the endoscope is pulled out from the patient's body. Then, other necessary procedures are performed, and the series of operations ends.

[0178] Fourth embodiment

[0179] In the Figure 24 , the clip unit 10 includes a clip (clip body) 11 and a pressure tube 31. The pressure tube 31 houses at least the proximal end portion of the clip 11. The proximal end of the pressure tube 31 is connected to the distal end of the insertion portion 60 by the connecting member 63. The operation wire 62 passes through the passage inside the insertion portion 60. The connecting member 63A connects the distal end of the operation wire 62 and the proximal end portion of the clip 11.

[0180] As shown in Figure 24 , the clip 11 of the present embodiment includes two arm portions 12, 13. The arm portions 12, 13 include a first pin 110 (intermediate member) at their proximal end portions, and the two arm portions 12, 13 are movably connected by the first pin 110. The two arm portions 12, 13 also have long grooves 121, 131 through which a second pin 120 passes. The second pin 120 inserted into the long grooves 121, 131 can slide along the long grooves 121, 131. The both ends of the second pin 120 are fixed to the pressure tube 31. If the first pin 110 is moved back and forth by the operation wire 62, the second pin 120 slides along the long grooves 121, 131, and the two arm portions 12, 13 open and close, and the front ends 12a, 13a of the arm portions grip or release the target tissue.

[0181] As shown in Figure 24 , Figure 25As shown, the crimp tube 31 is a hollow cylindrical tube with a distal opening 311 and a proximal opening 312. The tube wall of the crimp tube 31 has two opposing tube wall grooves 313, through which the two arms 12 and 13 pass when opened. In addition, the crimp tube 31 also has a pair of pin holes 314 in the tube wall for fixing the two ends of the second pin 120.

[0182] like Figure 24 , 26 As shown, the connecting component 63A in this embodiment includes a first connecting component 63Aa and a second connecting component 63Ab. The first connecting component 63Aa and the second connecting component 63Ab are respectively connected to both ends of the first pin 110 and abut against the two arms 12 and 13 from both sides. The first connecting component 63Aa and the second connecting component 63Ab can have the same shape and size.

[0183] Figure 27 This is a side view of the first connecting component 63Aa. The first connecting component 63Aa is integrally formed from a long strip of metal sheet. Figure 27 As shown, the first connecting member 63Aa includes a distal end 63Aa1, a main body 63Aa2, and a proximal end 63Aa3 from the distal end side.

[0184] The proximal end 63Aa3 of the first connecting member 63Aa is connected to the distal end of the operating line 62. The width of the proximal end 63Aa3 is smaller than the width of the distal end 63Aa1 and the main body 63Aa2.

[0185] The distal end 63Aa1 of the first connecting member 63Aa is the first hook (joint portion). Similarly, the distal end of the second connecting member 63Ab is the second hook (joint portion). The first hook 63Aa4 and the second hook are C-shaped, forming internal spaces that hook the ends of the first pin 110. That is, the first hook 63Aa4 and the second hook hook the two ends of the first pin 110 respectively. When separating the clamp 11 and the connecting member 63A, if the operating line 62 is pulled towards the proximal end, the first hook and the second hook will deform under force, releasing the connection with the first pin.

[0186] The two arms 12 and 13 are located between the first hook 63Aa4 and the second hook. Preferably, the first hook 63Aa4 and the second hook abut against the arms 12 and 13 from both sides to prevent the arms 12 and 13 from moving axially in the first pin 110.

[0187] like Figure 27 As shown, the abutment portion 63Aa5 extends from the first hook 63Aa4, increasing the contact area with the arm. The abutment portion 63Aa5 can be integrally formed with the first hook, or it can be formed separately and then combined.

[0188] Preferably, the portion of the connecting member in which the abutting portion is formed has a width greater than that of other portions of the connecting member. For example, as shown in Figure 27 the width W1 of the portion of the first connecting member 63Aa in which the abutting portion 63Aa5 is formed is greater than the width W2 of the main body portion 63Aa2.

[0189] The thickness of the abutting portion 63Aa5 is the same as that of the first hook 63Aa4. Alternatively, as shown in Figure 28 the thickness of the abutting portion 63Aa5 can be greater than that of the first hook 63Aa4. In the first connecting member 63Aa, the thickness of the portion in which the abutting portion 63Aa5 is formed is greater than that of other portions of the first connecting member 63Aa, for example, greater than the thickness of the main body portion 63Aa2. Further, in the case where the thickness of the first hook 63Aa4 is greater than that of the main body portion 63Aa2 and sufficient strength of the first hook 63Aa4 can be maintained, the abutting portion 63Aa5 can not be provided.

[0190] As shown in Figure 27 the abutting portion 63Aa5 is continuously formed. Further, the abutting portion 63Aa5 can be discontinuously formed. In the case where the abutting portion 63Aa5 is discontinuously formed, preferably, the abutting portion 63Aa5 is formed in a region where the force acting on the hook when the operating wire 62 is pulled back is most concentrated, on the hook, to avoid breakage of the hook. For example, as shown in Figure 29 the abutting portion is formed at least in a region from the root of the hook to the distal end of the hook in the length axis direction of the connecting member. Further, for example, a plurality of abutting portions discontinuously formed can extend radially from the hook.

[0191] The second connecting member is formed with the same abutting portion as the abutting portion 63Aa5 of the first connecting member, and repeated description is omitted here.

[0192] Since the abutting portions are formed in the first and second hooks, the abutting area with the arm portion is increased, so that the wobble between the hook and the arm portion can be suppressed and the connection stability between the connecting member and the arm portion can be ensured. In particular, since the width of the portion of the connecting member in which the abutting portion is formed is greater than that of other portions of the connecting member, the rotation of the connecting member about the length axis thereof can be effectively suppressed.

[0193] Further, since the abutting portion functions to increase the width or thickness of the hook, the strength of the hook is enhanced. Therefore, when the operating wire 62 is pulled toward the proximal end side in order to separate the clip and the connecting member, the hook breaks only by deforming to disengage the first pin, and the possibility of breakage of the hook is small.

[0194] In the case where the abutting portion is discontinuously formed, the force required to deform the hook is small, and the possibility of breakage of the hook is also small. The resistance of the hook against deformation can be appropriately weighed.

[0195] Fifth Implementation Method

[0196] The fifth embodiment differs from the fourth embodiment in that the structures of the two connecting components are different. In this embodiment, the distal end of the connecting component is not a hook, but a joint portion with two opposing engaging claws.

[0197] In the fifth embodiment, the two connecting parts are identical. Therefore, the first connecting part 63B will be used as an example for explanation.

[0198] like Figure 30 As shown, the first connecting member 63B includes a joint portion 63B1 (i.e., the distal end portion), a main body portion 63B6, and a proximal end portion 63B7 from the distal end side.

[0199] The two engaging claws 63B2 constituting the joint 63B1 form a receiving portion 63B3 and a notch 63B4 between each other. The receiving portion 63B3 receives the first pin 110. The gap between the two engaging claws 63B2 at the notch 63B4 is smaller than the outer diameter of the first pin 110, allowing the first pin 110 to be pushed into the receiving portion 63B3 via the notch 63B4. Therefore, the first pin 110 can be embedded between the two engaging claws 63B2. With the first pin 110 embedded between the two engaging claws 63B2, if the first pin 110 is pulled out from between the two engaging claws 63B2, the two engaging claws 63B2 will deform, and the first pin 110 will disengage from between the two engaging claws 63B2.

[0200] The first connecting member 63B, including the joint 63B1, is a plate-shaped member that abuts against the arms 12 and 13 from both sides to prevent the arms 12 and 13 from moving axially in the first pin 110. When the clamp 11 and the first connecting member 63B are separated, if the operating line 62 is pulled towards the proximal end, the two engaging claws 63B2 are deformed by force, and the first pin 110 disengages from the receiving part 63B3 through the cut 63B4, thus releasing the connection between the first connecting member 63B and the first pin 110.

[0201] like Figure 30 As shown, the abutment portion 63B5 extends from the edge of the engaging claw 63B2, increasing the abutment area with the arms 12 and 13. The abutment portion 63B5 can be integrally formed with the first connecting member 63B, or it can be formed separately and then joined together. Preferably, the width W1 of the portion of the first connecting member 63B where the abutment portion 63B5 is formed is greater than the width W2 of the other portions of the first connecting member 63B.

[0202] The thickness of the abutment portion 63B5 can be the same as the thickness of the engagement claw 63B2. Alternatively, as Figure 31As shown, the thickness of the abutment portion 63B5 can be greater than the thickness of the engagement claw 63B2. In the first connecting member 63B, the thickness of the portion in which the abutment portion 63B5 is formed can be greater than the thickness of other portions of the first connecting member 63B. Further, in a case where the thickness of the engagement claw 63B2 is greater than the thickness of the main body portion 63B6 and the sufficient strength of the engagement claw 63B2 can be maintained, the abutment portion 63B5 can not be provided.

[0203] As shown, the abutment portion 63B5 is continuously formed. Further, the abutment portion 63B5 can be discontinuously formed. For example, a plurality of abutment portions 63B5 discontinuously formed can extend radially from the engagement claw 63B2. Figure 30

[0204] In the second connecting member, the same abutment portion as the abutment portion 63B5 of the first connecting member 63B is formed, and the repeated description is omitted here.

[0205] As with the fourth embodiment, since the abutment portion is formed in the engagement portion, the abutment area with the arm portion increases, so the wobble between the engagement portion and the arm portion can be suppressed, and the connection stability between the connecting member and the arm portion can be ensured. In particular, the width of the portion of the connecting member in which the abutment portion is formed is greater than the width of other portions of the connecting member, so the rotation of the connecting member about the length axis thereof can be effectively suppressed.

[0206] Further, since the abutment portion functions to increase the width or the thickness of the engagement portion, the strength of the engagement portion is enhanced. Therefore, when the operation wire 62 is pulled toward the proximal side in order to separate the clip and the connecting member, the engagement claw only deforms to disengage the first pin, and the possibility that the engagement claw is broken is small.

[0207] In a case where the abutment portion is discontinuously formed, the force required to deform the engagement claw is small, and the possibility that the engagement claw is broken is also small. The resistance of the engagement claw against deformation can be appropriately weighed.

[0208] The above describes the preferred embodiments of the present application, but these are merely exemplary descriptions of the present application, and are not limitations of the present application. The addition, omission, replacement, and other modifications of technical features can be implemented without departing from the concept and scope of the present application. Accordingly, the present application should not be construed as being limited in the above description. The present application is defined only by the scope of the claims.

[0209] ​The various embodiments have been disclosed above, but these are merely exemplary and not limiting of the present application. Similarly, the various figures have been presented for the purpose of illustration and description and are not intended to limit the aspects of the present application. The intended aspects of the present application can be implemented in a variety of ways, including variations of the embodiments described herein. Such variations are not to be regarded as a departure from the spirit and scope of the present application, and those skilled in the art will recognize, and be able to affect such modifications, permutations, and subsets of the application. The application is not limited to the embodiments chosen for illustration, but is to be accorded the full scope consistent with the language of the following claims, including full equivalents of the claims.

[0210] The various embodiments, technical features, configurations, and functions in one or more of the embodiments described above are not limited to these embodiments, but can be applied individually or in combination to other embodiments, whether or not such embodiments are described or the corresponding technical features are described in other embodiments. Therefore, the scope of protection of the present application is not limited to the embodiments described in the specification.

[0211] Except where expressly stated to the contrary, terms, phrases, and expressions used throughout the description are to be understood as open-ended, unless otherwise stated or apparent from context. For example, the phrase "comprising" is to be construed as "comprising, without limitation." The phrase "an example" is to be construed as "an example, without limitation." The phrase "one" is to be construed as "at least one," "one or more," or "one or more and more." The phrases "existing," "conventional," "typical," "standard," "known," and the like, are to be construed as present, conventional, typical, or standard as of the filing date of this patent application, unless otherwise stated or apparent from context. Similarly, the phrase "generally known to those skilled in the art" or the like, is to be construed as including what is known to those skilled in the art in the present or future.

[0212] Certain expressions, such as "one or more," "at least," "not limited to," and the like, are not to be construed as limiting the scope of the claims to the narrower aspects of the embodiments, unless expressly stated to the contrary. The phrase "comprising" is to be construed as "comprising, without limitation."

[0213] Furthermore, the various embodiments described herein are described in the general context of method steps or processes, which can be implemented in one or more computer systems or the like, as well as in the context of selectively activating or deactivating certain functions and features. Such steps can be recognized, by those skilled in the art, as one or more hardware and / or software modules that execute on one or more computers in a network environment. Furthermore, any action taken by a computer system, or the like, can be understood as being performed by the computer system in response to its processing of the results of any action taken by a computer system, or the like.

Claims

1. A clamping device, comprising: A clamp, comprising two arms and a middle component connecting the two arms through the proximal ends of the two arms; A clamping tube that receives at least the proximal end of the clamp, including a tube wall groove for passage of the two arms when they are open; The connecting component connects the operating line to the intermediate component. The clamping device is characterized in that... The distal end of the connecting component has a joint portion that engages with the intermediate component. The connecting component also has an abutment portion, which, when the connecting portion is engaged with the intermediate component, extends from the connecting portion to a lateral position on the arm and abuts against the arm laterally. The width of the portion of the connecting member where the abutment is formed is greater than the width of the other portions of the connecting member.

2. The clamping device as described in claim 1, characterized in that, The engagement portion is a hook that engages with the intermediate component.

3. The clamping device as described in claim 1, characterized in that, The joint has two opposing engagement claws. The intermediate component can be embedded between the two engaging claws. With the intermediate component embedded between the two engagement claws, if the intermediate component is pulled out from between the two engagement claws, the two engagement claws deform and the intermediate component disengages from between the two engagement claws.

4. The clamping device as described in any one of claims 1 to 3, characterized in that, The intermediate component is a pin.

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