Endoscope treatment tool

Abstract

The present invention provides a treatment instrument for an endoscope capable of preventing a ring member from slipping off an opening / closing portion and reliably cutting off the ring member through the opening / closing portion. A clip device (10) has a link hook (11) protruding from an inner sheath (12) to open by its own elastic force and being buried in the inner sheath (12) to close. The link hook (11) has a claw portion (11a1, 11b1) capable of holding a part of an endoscope traction clip (1) having the ring member (4) linked thereto and pulling it into the inner sheath (12) in cooperation with an operation of being buried in the inner sheath (12). A gap of a closest portion between the claw portions (11a1, 11b1) in a state where the pair of arm portions (11a, 11b) are buried in the inner sheath (12) to close has a prescribed value to prevent the ring member (4) from slipping off in a case where a part of the ring member (4) is held between the claw portions (11a1, 11b1).

Description

Technical Field

[0001] This invention relates to an endoscopic treatment device for treating internal tissues through external manipulation using an endoscope. More specifically, it relates to an endoscopic treatment device that has a connecting hook for connecting a medical clamp and also serves to cut off a ring member that transports the medical clamp into the body. Background Technology

[0002] The clamp device, as an endoscopic treatment instrument, is used in situations such as endoscopic submucosal dissection (ESD) where, for hemostasis, marking, etc., a medical clamp connected to the tip of the sheath through the guide tube of the treatment instrument passing through the endoscope is placed in place to hold the tissue in place by operation from the operating part mounted at the rear end of the sheath.

[0003] As an existing clamping device, it is known to be equipped with a connecting hook (opening and closing part) (for example, see Patent Document 1). The connecting hook has a pair of arms arranged in a generally V-shape at the distal end of the drive wire inserted in the sheath and a U-shaped part connecting the ends of these bases. By sliding the sheath relative to the drive wire towards the proximal end, it protrudes from the distal end of the sheath and opens by its own elasticity. By sliding it towards the distal end, it is buried in the distal end of the sheath and closes.

[0004] In the clamp device disclosed in Patent Document 1, the connecting hook is used not only to connect the medical clamp to the body and deliver it into the body and hold (clamp) the tissue in the body, but also to cut the ring member that is connected to the medical clamp and delivered into the body. There is no need to prepare a separate cutting tool for cutting the ring member, which can reduce the cost of disposal.

[0005] Existing technical documents

[0006] Patent documents

[0007] Patent document 1: International Publication No. 2019 / 066084. Summary of the Invention

[0008] The problem the invention aims to solve

[0009] In the clamping device disclosed in Patent Document 1 (hereinafter referred to as the prior art clamping device), when the ring member is cut by the connecting hook (opening and closing part), a portion of the ring member is first held between the claws of each of the pair of arms of the opening and closing part. In this state, the pair of arms and the ring member are pulled into the sheath together (refer to Patent Document 1). Figure 8 A, Figure 8B). Then, the pair of arms and the ring member are pulled further into the sheath, at which point the ring member contacts the inner diameter of the sheath through its circumferential surface, and the shearing force accompanying the pulling cuts the ring member (see Patent Document 1). Figure 8 C).

[0010] As an example, Figure 18 illustrates the step of cutting the ring member 95 using the opening / closing portion 90 in a prior art clamping device 100. As shown in Figure 18, in the prior art clamping device 100, a portion of the ring member 95 is held between the respective top ends (claw portions 90b, 90b) of a pair of arms 90a, 90a of the opening / closing portion 90 (see Figure 18). Figure 18A While maintaining this state, the pair of arms 90a, 90a together with the ring member 95 are pulled into the sheath 92 (see reference). Figure 18B , Figure 18C In some cases, the ring member 95 slips out from between the claws 90b and 90b of a pair of arms 90a and 90a.

[0011] One of the main reasons is that in the existing clamp device 100, the opening and closing part 90 is a structure that can satisfy functions such as connecting medical clamps and holding internal tissues, rather than the original function of cutting the ring member 95. There are no measures to determine the value of the gap between the claws 90b, 90b, so that the ring member 95 does not slip when cutting the ring member 95 after ESD surgery.

[0012] Therefore, in the prior art clamp device 100, there is a problem that, in the series of operations shown in FIG18 for cutting the ring member 95, when the opening and closing part 90 is pulled into the inner sheath 92 while holding the ring member 95 (see reference...), Figure 18B During the process of further pulling the ring member 95 deeper into the inner sheath 92, the ring member 95 sometimes slips out from between the claw portions 90b, 90b of the opening and closing portion 90 (see reference). Figure 18C The ring component 95 cannot be reliably cut.

[0013] The present invention was made in view of the above-mentioned problems, and its object is to provide an endoscopic treatment device that can prevent the ring member from slipping off the opening and closing part and reliably cut off the ring member through the opening and closing part.

[0014] Solution for solving the problem

[0015] To achieve the above objectives, the endoscopic treatment device of the present invention is characterized by having: a tubular sheath; an operating part disposed at the proximal end of the sheath, allowing a drive wire inserted in the sheath to slide relative to the sheath; and an opening / closing part mounted at the distal end of the drive wire, formed of an elastic body having a pair of arms, the pair of arms being arranged to open in a generally V-shape toward their apexes, the opening / closing part protruding from the distal end of the sheath and opening elastically by sliding the sheath relative to the drive wire toward the proximal end, and by allowing the sheath to slide relative to the drive wire. The drive wire slides to the distal end and closes by being submerged in the distal end of the sheath. The opening and closing part has a pair of claws at the respective ends of the pair of arms. The pair of claws bend towards each other in the closing direction and can cooperate with the action of being submerged in the sheath to hold a part of the clamp connected to the ring member and pull it into the sheath. The gap between the closest parts of the pair of claws when the pair of arms are submerged in the sheath and closed has a predetermined value to prevent the ring member from slipping when a part of the ring member is held between the pair of claws.

[0016] According to the above structure, an endoscopic treatment device can be provided that can eliminate slippage of the ring member and reliably cut off the ring member during the process of accommodating a portion of the ring member between a pair of claws and pulling it into the sheath.

[0017] Furthermore, in the endoscopic treatment device of the present invention, the structure may be as follows: in the opening and closing portion, the first claw portion of the claw portion, which is one of the pair of arms, bends from its base end with a predetermined diameter, and the second claw portion of the claw portion, which is the other arm, bends from its base end in a manner that is longer than the first claw portion and has a diameter larger than the predetermined diameter. When the pair of arms are submerged in the sheath, they close by the second claw portion covering the first claw portion from the outside, and the closest portion is formed between the tip of the first claw portion and the region from the tip of the second claw portion to the base end.

[0018] Based on the above structure, an endoscopic treatment device can be realized that prevents the first claw and the second claw from interfering with each other when the pair of arms are buried in the sheath and closed, and can reliably cut the ring member without hindering the operation when the pair of arms are buried in the sheath and closed.

[0019] Furthermore, in the endoscopic treatment device of the present invention, the predetermined value can be 0.15 mm or less.

[0020] According to the above structure, an endoscopic treatment device can reliably prevent the ring member from slipping and being cut off, even when the ring member is stretched due to tension applied to it, during the process of clamping a part of the ring member between a pair of claws and pulling it into the sheath.

[0021] Furthermore, in the endoscopic treatment device of the present invention, the structure may be such that the opening and closing part is a connecting hook that is detachably connected to a medical clamp for holding tissues in the body.

[0022] According to the endoscopic treatment device having the above structure, a clamp device that can be preferably used as an endoscopic treatment device has a connecting hook that can be detachably connected to a medical clamp that holds tissue in the body as the opening and closing part. Attached Figure Description

[0023] Figure 1 This is a diagram showing the appearance of the clamp device according to an embodiment of the present invention.

[0024] Figure 2 For along Figure 1 A cross-sectional view of the Va-Va line.

[0025] Figure 3 To indicate Figure 1 A three-dimensional view of the connecting hook of the clamp device and the structure around it.

[0026] Figure 4A To indicate that Figure 1 The diagram shows the clamp device with the connecting hook protruding.

[0027] Figure 4B To indicate Figure 1 The diagram shows the pulled-in state of the connecting hook of the clamp device.

[0028] Figure 5 To indicate Figure 4B A conceptual diagram of the inner sheath and connecting hook in the pulled-in state, viewed from the side.

[0029] Figure 6 To enlarge the representation Figure 5 A diagram of the structure inside the circle.

[0030] Figure 7 This diagram shows the overall structure of the endoscope traction clamp body in the open state of the clamp body of the clamp device used in an embodiment of the present invention.

[0031] Figure 8 To change the composition Figure 7 The diagram shows the orientation of the main body of the traction clamp.

[0032] Figure 9 To indicate Figure 7 The diagram shows the closed state of the arm of the traction clamp body.

[0033] Figure 10A for Figure 7 The diagram shows an enlarged view of the helical spring of the traction clamp, and is also the front view of the helical spring.

[0034] Figure 10B To observe from the assembly side of the ring component Figure 10A A diagram of a helical spring.

[0035] Figure 11A for Figure 7 The enlarged structural diagram of the traction clamp is a top view of the ring component.

[0036] Figure 11B for Figure 11A The front view of the ring component.

[0037] Figure 12 To indicate that Figure 7 The diagram shows the traction clamp protruding from the top of the clamping device.

[0038] Figure 13 To indicate that Figure 7 The diagram shows the traction clamp stored at the top of the clamp device.

[0039] Figure 14 For illustrative purposes only. Figure 7 The image shows the state of the traction clamp cutting open a portion of the lesion.

[0040] Figure 15 To indicate completion illustratively Figure 14 The diagram shows the subsequent incision of the lesion, with the tip of the clamp device brought close together in order to cut the ring component.

[0041] Figure 16A To indicate cutting off Figure 7 The diagram shows the process of the ring component of the traction clamp, indicating that the top of the clamp device is positioned near the ring component, so that the connecting hook protrudes.

[0042] Figure 16B To indicate cutting off Figure 7 A diagram showing the process of the ring component of the traction clamp. Figure 16A In the next step, a portion of the ring component is held by a connecting hook and pulled into the connecting hook from the top of the sheath, so that the ring component is in contact with the far end of the inner sheath.

[0043] Figure 16C To indicate cutting off Figure 7 A diagram showing the process of the ring component of the traction clamp. Figure 16BIn the next step, the connecting hook is pulled further in from the top of the inner sheath. The force generated by the top of the inner sheath and the connecting hook on the ring component cuts off the state of the ring component.

[0044] Figure 17 This diagram illustrates the closed configuration between a pair of claws when the connecting hook of the clamp device according to an embodiment of the present invention is pulled into the sheath.

[0045] Figure 18A The diagram illustrates the slippage of the ring member during the process of cutting the ring member of the traction clamp using the connecting hook of an existing clamp device. It shows a state in which a portion of the ring member is held by the connecting hook and the ring member is abutted against the distal end of the inner sheath.

[0046] Figure 18B This diagram illustrates the slippage of the ring member during the process of cutting the ring member of the traction clamp using the connecting hook of an existing clamp device. Figure 18A The state in which the connecting hook is pulled in from the top of the inner sheath.

[0047] Figure 18C This diagram illustrates the slippage of the ring member during the process of cutting the ring member of the traction clamp using the connecting hook of an existing clamp device. Figure 18B The state in which the connecting hook is pulled further in from the top of the inner sheath. Detailed Implementation

[0048] Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings. Furthermore, to facilitate understanding of the structure of each part of the device, the relative dimensions of each part in the drawings may not necessarily correspond to the actual dimensions of the device.

[0049] The endoscopic treatment device according to the embodiments of the present invention is a device for treating internal tissues by means of an endoscope through external operation. As a mechanism for performing the above treatment, the endoscopic treatment device has an opening and closing part that can be operated to a state in which it protrudes from the top of the sheath and to a state in which it is buried in the sheath. When it protrudes from the top of the sheath, it opens into a generally V-shape, and when it is buried in the sheath, it closes.

[0050] Hereinafter, as an example, we will describe the application of the endoscopic treatment device of this embodiment to a clamp device. As an opening and closing part, the clamp device has a connecting hook that can be detachably connected to a medical clamp that holds tissue in the body.

[0051] <Structure of the clamp device>

[0052] First, refer to Figures 1-6 The structure of the clamp device in this embodiment will be described.

[0053] like Figure 1 As shown, the clamp device 10 is configured to generally include: a connecting hook 11, an inner sheath 12, a drive wire 13, an outer sheath 14, a reinforcing coil 15, a slider 16, a base 17, and an operating part 18.

[0054] A tubular outer sheath 14 contains an inner sheath 12, which is also tubular, and a drive wire 13 is inserted within the inner sheath 12. The inner sheath 12 can slide within the outer sheath 14, and the drive wire 13 can slide within the inner sheath 12.

[0055] The outer sheath 14 is formed of a flexible hollow tube, and in this embodiment, a coil is used. As the coil, a flat wire coil formed by winding a long strip of metal (stainless steel) into a spiral shape can be used. However, a round wire coil or a coil with a smooth inner surface can also be used. The inner diameter of the top part of the outer sheath 14 is approximately 2 to 3 mm.

[0056] The inner sheath 12 is formed of a flexible hollow tube, and in this embodiment, a metal wire tube is used. The metal wire tube is, for example, a hollow strand formed by twisting multiple metal wires (metal cables) made of metal (stainless steel) into a spiral shape. Alternatively, the inner sheath 12 can be made primarily of metal wire tube, with only a portion at its tip serving as a coil component. The inner diameter of the tip of the inner sheath 12 is approximately 1.5 to 2.5 mm.

[0057] The drive wire 13 is formed of a flexible metal wire, and in this embodiment, a metal wire rope is used. A metal wire rope is, for example, a rope formed by twisting multiple metal wires (metal cables) made of metal (stainless steel) into a spiral. However, the same metal wire tube as the inner sheath 12 can be used as the drive wire 13.

[0058] like Figure 3 As shown, the connecting hook 11 disposed at the top of the sheath of the clamp device 10 has a pair of arms 11a and 11b formed by elastic bodies arranged in a generally V-shape toward its top. Through coordinated action with the inner sheath 12, it can be in two states: an open state and a closed state. At the top of the arms 11a and 11b of the connecting hook 11, claws 11a1 and 11b1 are formed by bending inward (towards each other) respectively, which can grasp the connecting part 21 of the clamp body 2 for connection.

[0059] The base end of the connecting hook 11 is a U-shaped portion 11c that is continuous with the base ends of the pair of arms 11a and 11b and forms a generally U-shape. The arms 11a and 11b, including the claw portions 11a1 and 11b1, and the U-shaped portion 11c can be formed by appropriately bending (plastically deforming) a slender sheet material made of an elastomer. While not particularly limited, the sheet material constituting the connecting hook 11 has a thickness of approximately 0.20 to 0.24 mm and a width of approximately 0.6 mm. For example, stainless steel can be used as the sheet material.

[0060] At the tip (distal end) of the drive wire 13, which can be slidably inserted into the inner sheath 12, a roughly circular ring member 13a is integrally welded and fixed by means of laser welding or the like. The outer diameter of the circular ring member 13a is about 1.2 mm, and the inner diameter is about 0.8 to 1.0 mm.

[0061] The connecting hook 11 is mounted on the distal end of the drive wire 13 in a swivel manner by being arranged to pass through the annular member 13a and with the U-shaped portion 11c movably fitted into the annular member 13a. By mounting the connecting hook 11 to the tip of the drive wire 13 via the annular member 13a and the U-shaped portion 11c movably fitted into the annular member 13a, the connecting hook 11 can... Figure 3 The arrow a1 can rotate freely in the direction of the arrow. The connecting hook 11 constitutes the opening and closing part of the present invention.

[0062] Back Figure 1 and Figure 2 The outer sheath 14 is inserted into and integrally fixed to the reinforcing coil 15 near its base (proximal) side. The reinforcing coil 15 is integrally fixed to the slider 16, and a portion of the base 17 is inserted into the inner side of the slider 16. The slider 16 can be slidably positioned relative to the base 17 between two positions: a position moved to the top (distal) side and a position moved to the base end (proximal) side.

[0063] An operating part 18 is slidably held at the base 17, and an inner sheath 12 is fixed at the base 17. The base end of the drive wire 13 is fixed to the operating part 18.

[0064] When the operating part 18 slides relative to the base 17 toward the tip (distal side), the inner sheath 12 is pulled in relative to the drive wire 13, and the connecting hook 11 at the tip of the drive wire 13 protrudes from the tip of the inner sheath 12 and opens due to its own elasticity. When the operating part 18 slides relative to the base 17 toward the base end (proximal side), the drive wire 13 is pulled in relative to the inner sheath 12, and as the connecting hook 11 at the tip of the drive wire 13 enters the inner sheath 12, it gradually closes and is buried within the inner sheath 12, thereby completely closing.

[0065] When the slider 16 is slid relative to the base 17 toward the base end, the inner sheath 12 can protrude from the top of the outer sheath 14. Conversely, when the slider 16 is slid relative to the base 17 toward the top end, the top of the inner sheath 12 can be contained (embedded) inside the outer sheath 14.

[0066] <Structure of the connecting hook>

[0067] The structure of the connecting hook 11 of the clamp device 10 will be described in further detail.

[0068] Figure 4A and Figure 4B This diagram illustrates the operational state of the connecting hook 11 of the clamp device 10 according to this embodiment. Figure 4A This indicates that the connecting hook 11 of the clamp device 10 protrudes by sliding the operating part 18 relative to the base 17 towards the top (far end) side. Figure 4B This indicates the state during which the connecting hook 11 of the clamp device 10 is gradually closed as the operating part 18 slides relative to the base 17 towards the base end (proximal end). In this way, in the clamp device 10, the connecting hook 11 protrudes from the distal end of the inner sheath 12 and opens elastically by sliding the inner sheath 12 relative to the drive wire 13 towards the proximal end, and closes by sliding the inner sheath 12 relative to the drive wire 13 towards the distal end, thus being submerged within the distal end of the inner sheath 12.

[0069] Figure 5 To indicate that the connecting hook 11 will be from Figure 4B The diagram shown is a conceptual representation of the structure of the inner sheath 12 and the connecting hook 11, viewed from the side, in a state where the sheath 12 is further pulled deeper into the inner sheath 12. Furthermore, Figure 6 It is an enlarged representation Figure 5 A diagram of the main structural components of the inner sheath 12 and connecting hook 11 within the circle.

[0070] like Figure 4A , Figure 4B , Figure 5 as well as Figure 6 As shown, the connecting hook 11 has the following shape: the claw portion 11a1 of one of the pair of arms 11a and 11b bends from its base end 11a2 with a predetermined diameter, and the claw portion 11b1 of the other arm 11b bends from its base end 11b2 in a manner that is longer and has a larger diameter than the claw portion 11a1 of the arm 11a. The claw portions 11a1 of the arm 11a and 11b1 of the arm 11b respectively constitute the first claw portion and the second claw portion of the present invention.

[0071] Furthermore, in the connecting hook 11, as Figure 6In the state shown, when the claws are embedded in the inner sheath 12, the pair of arms 11a and 11b are closed by covering the claw 11a1 from the outside with the claw 11b1. The closest part of the two arms is formed between the tip 11a3 of the claw 11a1 of one arm 11a and the area 11b4 of the curved side (from the tip of the second claw to the base end) of the claw 11b1 of the other arm 11b. Here, the distance d between the closest part of the area 11b4 of the curved side of the claw 11b1 of one arm 11a and the claw 11b1 of the other arm 11b is designed to be, for example, 0.15 mm or less.

[0072] The aforementioned gap d (≤0.15 mm) is intended for use after the connecting hook 11 is applied to the lesion site in ESD (see reference). Figure 15 Cut the annular component 4 of the endoscope traction clamp 1 described later (see reference). Figure 7 When the ring member 4 is partially held by the claw portion 11a1 of arm 11a and the claw portion 11b1 of arm 11b, the value is set to prevent it from slipping off between the claw portion 11a1 and the claw portion 11b1.

[0073] The aforementioned endoscope traction clamp 1's ring member 4 is cut to Figure 16A , Figure 16B , Figure 16C The steps shown are performed. In this step, firstly, a portion of the ring member 4 is grasped between the claws 11a1 and 11b1 of the pair of arms 11a and 11b, and in this state, the connecting hook 11 and the ring member 4 are pulled into the inner sheath 12 together. During the process of pulling the connecting hook 11 and the ring member 4 into the inner sheath 12 together, the connecting hook 11, for example, uses the claws 11a1 and 11b1 of the pair of arms 11a and 11b to, for example... Figure 17 The clamp device 10 is operated by pulling it further into the depth of the inner sheath 12 at the position shown.

[0074] Each claw 11a1, 11b1 of the pair of arms 11a, 11b is, for example, housed in... Figure 17 In the position shown, the distance between the claws 11a1 and 11b1 of the pair of arms 11a and 11b is equal to the distance between the claws 11a1 and 11b1 of the pair of arms 11a and 11b. Figure 6 The gap value (=d) of the closest part shown is extremely close. At this time, the ring member 4 is stretched to Figure 17 The state shown by the dashed line, and having a cross-sectional diameter larger than the spacing between the claws 11a1 and 11b1, will not slip out of the gap between the claws 11a1 and 11b1 until the cut is completed. Regarding the cutting of the ring member 4, refer to... Figure 16A , Figure 16B , Figure 16C , Figure 17 This will be explained in detail later.

[0075] <Structure of the endoscopic traction clip>

[0076] like Figures 7-9 As shown, the endoscope traction clip 1 that can be used in the clip device 10 of this embodiment is configured to generally have a clip body 2, a helical spring 3 and a ring member 4. It is a spring-loaded clip that uses the helical spring 3 as a connecting member to connect the clip body 2 and the ring member 4.

[0077] However, the helical spring 3 is one example of a connecting member. Rubber, other elastic components, or even non-elastic components can also be used as connecting members. Furthermore, the connecting member can be omitted, and the ring member 4 can be directly connected (installed) to the clamp body 2 without a connecting member.

[0078] The clamp body 2 has a connecting plate portion (connecting portion) 21, a pair of arm plate portions (arm portions) 22, and a tightening ring 24. The connecting plate portion 21 has a generally U-shaped curved shape, and the arm plate portions 22 are integrally formed with each end of the U-shape in a manner that is continuous with each end of the U-shape and opens in a generally V-shape towards its top.

[0079] The fastening ring 24 is a ring-shaped component formed to be slidably fitted onto the connecting plate portion 21 at the base end of the arm plate portion 22. The fastening ring 24 is attached using a clamping device 10 (see reference 10). Figures 1-6 Referring to the sliding component, the clamp device 10 is configured to move freely relative to the inner sheath 12 and has a connecting hook (engaging member) 11 that can be detachably connected (engaged) to the connecting plate portion 21. With the connecting hook 11 engaged with the connecting plate portion 21, pulling the connecting hook 11 from the top end of the inner sheath 12 causes the tightening ring 24 to be pushed and slid by the top end of the inner sheath 12, thereby closing the arm plate portion 22.

[0080] A claw portion 23 is integrally formed at the top end of each arm plate portion 22. At the top end of the arm plate portion 22, the claw portion 23 is formed by bending inward (i.e., in the closing direction). Each claw portion 23 has a recessed notch (not shown) in the middle portion of its top end.

[0081] The connecting plate portion 21, the pair of arm plates 22, and the pair of claw portions 23 constituting the clamp body 2 are formed by bending a thin and slender sheet of material. The thickness of the sheet material constituting the clamp body 2 is not particularly limited, but is preferably 0.10 to 0.30 mm. A flexible sheet material is preferred, such as stainless steel.

[0082] like Figure 8As shown, each arm plate portion 22 has a base end portion 22a and a gripping portion 22b. A through portion 22c is formed in the gripping portion 22b of each arm plate portion 22. These through portions 22c are formed to maintain the desired strength of the arm plate portion 22 (gripping portion 22b). One of these through portions 22c also serves to connect the coil spring 3 to the clamp body 2, as detailed later.

[0083] A tension ring 24 is slidably embedded in the connecting plate portion 21. The tension ring 24 is composed of a generally cylindrical ring member. However, the tension ring 24 may also be composed of a spring formed by winding wire into a spiral shape. The tension ring 24 passes through the connecting plate portion 21 in a guide hole on its inner side, and is assembled (externally embedded) so that it can move (slide) axially between the outer periphery of the connecting plate portion 21 and the outer periphery of the base end portion 22a of the arm plate portion 22.

[0084] like Figure 7 or Figure 8 As shown, with the tightening ring 24 positioned rearward (connecting plate portion 21), the arm plate portion 22 is in an open (spread) state due to its own elasticity, as needed, such as Figure 9 As shown, by moving (sliding) the tightening ring 24 to the position near the top (base end 22a), it can be changed to a closed state where the arm plate portion 22 is closed.

[0085] The helical spring 3 is a tension helical spring formed by winding metal wire such as stainless steel. For example... Figure 10A and Figure 10B As shown, the helical spring 3 has a hook 32 for connecting to the clip body 2 at one end of the main body 31 formed by winding metal wire, and a straight hook 33 for assembling (installing) the ring member 4 at the other end of the main body 31. The hook 32 is formed by bending approximately one turn (or more than one turn) of one end of the metal wire (main body 31) wound into a generally cylindrical shape at approximately 90 degrees relative to a plane orthogonal to the axis of the main body 31. Alternatively, the hook 32 can be manufactured separately and welded to one end of the wound metal wire.

[0086] The hook portion 33 of the ring member is formed by bending a portion of the other end of the main body 31 inward in a roughly D-shape and shaping it into a straight line. From the viewpoint of preventing the ring member 4 from detaching, the tip 33a of the straight-shaped hook portion 33 is preferably as follows when connecting to the ring member 4 described later: Figure 10B The straight section, which is shaped into a straight line, may reach the wound metal wire (main body 31) as shown. However, if it is fixed by means of adhesive or the like after the connecting ring member 4, the top of the straight section may not reach the wound metal wire (main body 31).

[0087] like Figure 11A and Figure 11B As shown, the ring member 4 has a ring portion 41 and a connecting portion 42. The ring portion 41 is formed from a thermoplastic polymer molded part (in this embodiment, a thermoplastic polymer injection-molded article) mounted on a part of the clamp body 2 via a helical spring (connecting member) 3, and is formed in a ring shape (endless) capable of connecting (engaging) the connecting hook (engaging member) 11 of the clamp device 10 in a portion thereon. The connecting portion 42 is used for connecting with the helical spring 3. In this embodiment, the ring portion 41 has a shape that has the same cross-sectional shape (approximately circular) over the entire circumference and is approximately circular when viewed from above.

[0088] The ring portion 41 is configured to be flexible enough to be housed in the top end of the outer sheath 14 of the clamp device 10 described later, and when the connecting hook (engaging member) 11 is connected (engaged) to a part of the ring portion 41 using the clamp device 10, the connecting hook 11 is pulled in from the top end of the inner sheath 12 and cut off by the shearing force generated by the top end of the inner sheath 12 and the connecting hook 11.

[0089] More specifically, regarding the structural relationships such as the inner diameter of the top end of the outer sheath 14, the inner diameter of the top end of the inner sheath 12, and the structure of the connecting hook 11, the shape (ring shape, cross-sectional shape), size (diameter of the ring, diameter of the cross-section), material, molding method, and molding conditions (molding temperature, pressure, etc.) were set so that the ring 41 has both the flexibility to be housed inside the outer sheath 14 and the brittleness to be cut by the shear force generated by the top end of the inner sheath 12 and the connecting hook 11.

[0090] In this embodiment, the joint 42 is a generally rectangular plate-shaped portion integrally formed with the ring portion 41, and has a spring through hole 42a extending in a direction substantially perpendicular to the plate surface. This spring through hole 42a is a generally circular hole into which the hook portion (straight portion) 33 of the ring member of the coil spring 3 can be inserted. The inner diameter of the spring through hole 42a is set to be equal to or slightly larger than the outer diameter of the hook portion (straight portion) 33 of the ring member of the coil spring 3.

[0091] In this embodiment, the joining portion 42 and the ring portion 41 are formed together by integral injection molding. However, the joining portion 42 can also be joined to the ring portion 41 as a separate joining member. In this case, the joining member is not limited to a generally rectangular plate-shaped member like the joining portion 42. Other shapes and structures are also possible as long as they can realize the function of connecting the helical spring 3 to the ring portion 41.

[0092] Regarding the connection between the ring member 4 and the coil spring 3, the hook portion (straight portion) 33 of the ring member of the coil spring 3 is elastically deformed outward (in the direction away from the end of the top portion 33a from the main body portion 31) and inserted (penetrated) into the spring through hole 42a of the joint portion 42 in a through manner. The open end of the joint portion 42 is inserted and positioned inside the coil spring 3 (main body portion 31), and the elastic deformation of the hook portion 33 is released. Thus, the ring member 4 is connected (installed) to the coil spring 3. This facilitates the connection of the joint portion 42 to the coil spring 3 and prevents the joint portion 42 from detaching from the coil spring 3. Alternatively, to more reliably prevent the joint portion 42 from detaching from the coil spring 3, the portion of the hook portion 33 that contacts the spring through hole 42a of the joint portion 42 can be glued together.

[0093] Thermoplastic polymers are used as the material for the ring member 4. Examples of thermoplastic elastomers include polypropylene, polyethylene, polyamide, polystyrene, and polyolefin-based elastomers, polyamide-based elastomers, polystyrene-based elastomers, and polyurethane-based elastomers. The diameter of the ring portion 41 (outer diameter) can be approximately φ2 to 6 mm, and the cross-sectional diameter of the ring portion 41 can be approximately 0.2 to 0.5 mm. The diameter of the through hole 42a for the spring can be approximately 0.1 to 0.3 mm.

[0094] The ring member 4 (ring portion 41) of the endoscopic traction clip 1 described above has a generally circular shape when viewed from above, but it is not limited to this. It can also be elliptical, oblong, polygonal (e.g., rhomboid), or a portion thereof combined with two or more of them to form a ring shape. For example, it can be a ring shape composed of a semi-circular (arc-shaped) portion and a semi-rhomboid (V-shaped) portion.

[0095] Furthermore, regarding the position of the joint 42 relative to the ring 41, in this embodiment, since the ring 41 is approximately circular, it can be positioned arbitrarily. However, if the ring 41 has a flat shape such as an ellipse, it is preferable to position it on one side along the major axis. If the ring 41 is a ring shape composed of a semi-circular (or semi-elliptical) portion and a semi-rhomboid (V-shaped) portion, the joint 42 is preferably positioned at the apex of the V-shaped portion.

[0096] Furthermore, in this embodiment, the cross-sectional shape of the ring portion 41 is approximately circular, but it is not limited to this; it may also be elliptical, oblong, or polygonal.

[0097] Furthermore, in this embodiment, the ring portion 41 of the ring member 4 has the same approximately circular cross-section over its entire circumference. However, it is also possible to set the diameter of a portion of the ring portion 41 of the ring member 4 to be thinner than that of other portions, making this portion a vulnerable part that can be cut with a weaker force compared to the other portions. By cutting such a vulnerable part with the clamping device 10, it is possible to easily cut it with a weaker force.

[0098] The endoscope described above is assembled with a traction clip 1 and stored at the top (distal end) of the clip device 10. The sheath (inner sheath 12, outer sheath 14) of the clip device 10 is inserted into the cavity of the endoscope and guided to the biological tissue that needs to be treated.

[0099] <How to use the endoscopic traction clip>

[0100] Next, the method of using the endoscopic traction clip 1 described above will be explained. In the clip body 2, a tightening ring 24 is externally fitted around the base end 22a near the outer periphery of the connecting plate portion 21. In this state, a connecting hole 25 is formed in the U-shaped connecting plate portion 21 (see reference). Figure 8 , Figure 12 The clamp device 10 of this embodiment (see reference 25) is connected via the connecting hole 25. Figure 1 The connecting hook 11 engages and is pulled into the inner sheath 12, thereby closing the connecting hook 11 and mounting the clamp body 2 of the endoscope traction clamp 1 to the top of the inner sheath 12 (see reference). Figure 12 ).

[0101] In this state, the top end of the inner sheath 12, which is connected to the endoscope traction clip 1 (clip body 2, spiral spring 3, and ring member 4), is pulled into the outer sheath 14, as follows. Figure 13 As shown, the endoscope traction clamp 1 (clamp body 2, coil spring 3, and ring member 4) is entirely housed inside the distal end of the outer sheath 14. In this state, the clamping ring 24 of the clamp body 2 remains in the position of the connecting plate portion 21, and the arm plate portion 22 is closed by the action of the inner wall of the outer sheath 54. Furthermore, the ring portion 41 of the ring member 4 is elastically deformed and housed within the outer sheath 14 by the action of the inner wall of the outer sheath 14.

[0102] Using an endoscope (not shown), position the tip of the sheath of the clamp device 10, which is equipped with the endoscopic traction clamp 1, near the biological tissue to be cut (dissected). Next, by sliding the outer sheath 14 towards the base, the endoscopic traction clamp 1 protrudes from the distal end of the outer sheath 14. Thus, as... Figure 12 As shown, the arm plate portion 22 is opened by its own elasticity, and the ring portion 41 of the ring member 4 returns to its original shape by its own elasticity.

[0103] For example, such as Figure 14 As shown, the arm plate portion 22 is positioned in the open state near the site (lesion) X where mucosal (biological tissue) resection (dissection) is required. Next, by sliding the inner sheath 12 relative to the drive wire 13 towards the tip, the tightening ring 24 slides towards the tip of the arm plate portion 22. As a result, the arm plate portions 22 gradually close (come closer to each other), clamping the lesion X, causing the mucosa on one side to be pulled closer to the mucosa on the other side.

[0104] By sliding the inner sheath 12 further towards the tip relative to the drive wire 13, the tightening ring 24 moves towards the holding portion 22b of the arm plate portion 22 (see reference). Figure 9 The endoscopic traction clamp 1 (clamp body 2) was used to hold the lesion X. In this state, by sliding the inner sheath 12 relative to the drive wire 13 towards the base, the connecting hook 11 was pushed out from the distal end of the inner sheath 12 and opened, releasing the endoscopic traction clamp 1 (clamp body 2) from holding (engaging) the connecting hook 11, thus completing the clamping of the lesion X by the endoscopic traction clamp 1 (clamp body 2).

[0105] Next, temporarily remove the clamp device 10 from the endoscope. Then, attach another prepared clamp (a general clamp) 7 to the top of the clamp device 10 (or another prepared clamp device with the same structure as the clamp device 10), and move the top of the sheath of the clamp device 10, with the general clamp 7 attached, to the vicinity of the appropriate location (opposing location) Y facing (opposite) to the lesion X. Furthermore, the general clamp 7 can be used with... Figures 7-9 The endoscope traction clamp 1 shown is a clamp with the same structure as the clamp body 2 of the helical spring 3 and the ring member 4.

[0106] Next, while using one of the pair of arm plates 72 of the general clamp 7 to lift the ring portion 41 of the ring member 4 (so that a part of the ring portion 41 is located between the pair of arm plates 72), and stretching the coil spring 3, the general clamp 7 is clamped at the opposing position Y in the same manner as the clamp body 2 is used to hold the lesion X. Thus, the lesion X is pulled (lifted) by the elastic force (tension) of the coil spring 3. After reaching this position, an endoscopic electrocautery 8 is inserted through the endoscope, and the circumference of the lesion X is cut open using the endoscopic electrocautery 8. Because the part of the lesion X that has been cut open and detached is lifted by the elastic force (tension) of the coil spring 3, the part of the lesion X that has been cut open and detached does not obstruct the field of vision or hinder the operation, allowing the entire circumference of the lesion X to be easily and reliably cut open.

[0107] Next, as Figure 15As shown, after the lesion X has been removed and the endoscopic electrosurgical scalpel 8 has been withdrawn from the endoscope, the tip of the clamp device 10 (or another prepared clamp device with the same structure as the clamp device 10) in its unattached (unconnected) state is positioned near the ring portion 41 of the traction ring member 4, and the connecting hook 11 protrudes from the tip of the inner sheath 12 and opens. In this state, as Figure 16A As shown, its position is finely adjusted in a manner that allows it to hold an appropriate portion of the ring 41.

[0108] Next, the inner sheath 12 is pushed towards the tip relative to the drive wire 13 to close the connecting hook 11, as follows. Figure 16B As shown, the ring 41 is held in place by the connecting hook 11, so that the ring 41 abuts against the top of the inner sheath 12. Then, as... Figure 16C As shown, by sliding and pulling the drive wire 13 relative to the inner sheath 12 towards the base end, the appropriate portion of the ring 41 is cut off by the shearing force generated by the tip of the inner sheath 12 and the connecting hook 11. Furthermore, after cutting the ring 41, the lesion X can be removed from the body by being held together with the traction clamp 1 by the connecting hook 11 of the clamp device 10 or by endoscopic forceps.

[0109] The closed state between the pair of claws 11a1 and 11b1 when the connecting hook 11 of the clamp device 10 in this embodiment is shown in the inner sheath 12. Figure 17 .exist Figure 17 In the closed state shown, with the pair of arms 11a and 11b in their concealed position, the gap (pitch d) between the closest portions of the claws 11a1 and 11b1 of the arms 11a and 11b becomes a value extremely close to 0.15 mm or less. In this state, the ring member 4 is stretched to... Figure 17 The state shown by the dashed line maintains a cross-sectional diameter larger than the distance between the claws 11a1 and 11b1, preventing slippage between the claws 11a1 and 11b1 until the cut is complete. Thus, by... Figure 17 The shown containment state further pulls the connecting hook 11 and the ring member 4 into the inner sheath 12, allowing a tensile force (tension) to be applied to the ring member 4 without it slipping out from between the claws 11a1 and 11b1 of the pair of arms 11a and 11b, thus reliably cutting off the ring member 4.

[0110] The clamp device 10 of this embodiment can pull and cut the ring member 4 (ring 41) of the endoscope traction clamp 1 into the inner sheath 12 while holding a portion of it between the claws 11a1, 11b1 of the pair of arms 11a, 11b of the connecting hook 11. Therefore, there is no need to prepare a separate cutting tool for cutting the ring member 4, which can reduce the cost of disposal.

[0111] Specifically, in the clamp device 10 of this embodiment, when the pair of arms 11a and 11b of the connecting hook 11 are closed and embedded in the inner sheath 12, the gap (d) between the closest portions of the claws 11a1 and 11b1 of the arms 11a and 11b is set to a predetermined value, for example, 0.15 mm, to prevent the ring member 4 (ring 41) gripping between the claws 11a1 and 11b1 from slipping off. Therefore, the clamp device 10 of this embodiment can maintain the ring member 4 (ring 41) tightly gripped between the claws 11a1 and 11b1 of the pair of arms 11a and 11b of the connecting hook 11, and reliably cut the ring member 4 (ring 41).

[0112] <The function of this implementation method>

[0113] The function of this embodiment will be explained below.

[0114] The clamp device 10 of this embodiment includes: a tubular sheath (inner sheath 12 and outer sheath 14); an operating part 18 disposed at the proximal end of the sheath, which allows a drive wire 13 inserted in the sheath to slide relative to the sheath; and a connecting hook 11 mounted at the distal end of the drive wire 13, formed of an elastic body having a pair of arms 11a, 11b, the pair of arms 11a, 11b being arranged to open in a generally V-shape toward each other towards their apex. The hook protrudes from the distal end of the inner sheath 12 and opens elastically by sliding the inner sheath 12 relative to the drive wire 13 proximal to the proximal end, and is submerged within the inner sheath 12 by sliding the inner sheath 12 relative to the drive wire 13 distal to the proximal end. The distal end of the end is closed, and the connecting hook 11 has a pair of claws 11a1 and 11b1 at the top of each of the pair of arms 11a and 11b. The pair of claws 11a1 and 11b1 bend towards each other in the closing direction and can cooperate with the action of being submerged in the sheath. The endoscope connected to the ring member 4 is held by a part of the traction clamp 1 and pulled into the sheath. When the pair of arms 11a and 11b are submerged in the inner sheath 12 and closed, the gap between the closest parts of the pair of claws 11a1 and 11b1 has a predetermined value to prevent the ring member 4 from slipping when a part of the ring member 4 is held between the pair of claws 11a1 and 11b1.

[0115] With this structure, the clamp device 10 of this embodiment can reliably cut the ring member 4 without slipping during the process of housing a portion of the ring member 4 between a pair of claws 11a1, 11b1 and pulling it into the inner sheath 12.

[0116] Furthermore, in the clamp device 10 of this embodiment, there is a structure in which, in the connecting hook 11, the claw (first claw) 11a1 of one of the pair of arms 11a and 11b bends from its base end 11a2 with a predetermined diameter, and the claw (second claw) 11b1 of the other arm 11b bends from its base end 11b2 in a manner that is longer than the first claw 11a and has a diameter that is larger than the predetermined diameter. When the arms 11a and 11b are buried in the inner sheath 12, the pair of arms 11a and 11b close together by the claw 11b1 covering the claw 11a1 from the outside, and the closest part is formed between the tip 11a3 of the claw 11a1 and the region 11b4 between the tip 11b3 of the claw 11b1 and the base end 11b2.

[0117] With this structure, when the clamp device 10 of this embodiment is closed with the pair of arms 11a and 11b buried in the inner sheath 12, it can prevent the first claw and the second claw from interfering with each other, and can reliably cut the ring member 4 without hindering the operation when the pair of arms 11a and 11b are buried in the inner sheath 12 and closed.

[0118] Furthermore, in the clamping device 10 of this embodiment, the aforementioned predetermined value is 0.15 mm or less. With this structure, the clamping device 10 of this embodiment can reliably prevent the ring member 4 from slipping and being cut off, even when the ring member 4 is stretched due to tension applied to it, during the process of clamping a part of the ring member 4 between a pair of claws 11a1, 11b1 and pulling it into the inner sheath 12.

[0119] Furthermore, in the clamp device 10 of this embodiment, the connecting hook 11 is configured to be connected to the medical clamp (endoscopic traction clamp 1) for holding internal tissue in a way that can be detached.

[0120] With this structure, the clamp device 10 of this embodiment can preferably be used as a clamp device for endoscopic treatment, having a connecting hook 11 as an opening and closing part that can be detachably connected to a medical clamp for holding tissue in the body.

[0121] According to the above embodiments, an example of applying an endoscopic treatment device to a clamp device has been given. However, the present invention is not limited to clamp devices and can be widely applied to endoscopic treatment devices having the following opening and closing parts, wherein the opening and closing parts are formed by an elastic body having a pair of arms, the pair of arms being arranged to open in a generally V-shape toward each other toward their apex, protruding from the distal end of the sheath by sliding the sheath relative to the drive wire toward the proximal side and opening by its own elasticity, and closing by sliding the sheath relative to the drive wire toward the distal side and being buried within the distal end of the sheath.

[0122] More specifically, it can be applied to, for example, a snare ligation device having a connecting hook connected to an indwelling snare for ligating internal tissue as the opening and closing part, a forceps device having forceps for holding internal tissue as the opening and closing part, a bipolar high-frequency device having a high-frequency electrode for opening and closing as the opening and closing part, and a ligation suture cutter that holds the ligation suture for suturing internal tissue defects with the opening and closing part and pulls it into a sheath to cut the ligation suture.

[0123] The embodiments described above are provided for ease of understanding of the present invention and are not intended to limit the present invention. Therefore, the elements disclosed in the above embodiments are intended to include all design changes or equivalents that fall within the scope of the present invention.

[0124] Explanation of reference numerals in the attached figures

[0125] 1: Endoscopic traction clamp (clamp)

[0126] 4: Ring components

[0127] 10: Clamping device (endoscopic handling instrument)

[0128] 11: Connecting hook (opening / closing part)

[0129] 11a, 11b: A pair of arms (arms)

[0130] 11a1: Claw portion (first claw portion)

[0131] 11a2: Base end portion of the first claw (base end portion)

[0132] 11a3: The tip of the first claw (tip)

[0133] 11b1: Claw portion (second claw portion)

[0134] 11b2: The basal end of the second claw (base end)

[0135] 11b3: The tip of the second claw (tip)

[0136] 11b4: Region from the tip of the second claw to the base (region) 12: Inner sheath (sheath)

[0137] 13: Drive wire

[0138] 14: Outer sheath

[0139] 18: Operations Department

Claims

1. An endoscopic treatment device, characterized in that, have: A tubular sheath; An operating part is provided at the proximal end of the sheath, which allows a drive wire inserted in the sheath to slide relative to the sheath; as well as The opening and closing portion, mounted at the distal end of the drive wire, is formed of an elastic body having a pair of arms arranged to open in a generally V-shape toward each other towards their apex. The opening and closing portion opens by elastically protruding from the distal end of the sheath relative to the drive wire by sliding the sheath proximally, and closes by sliding the sheath distally relative to the drive wire and being submerged within the distal end of the sheath. The opening and closing part has a pair of claws at the top of each of the pair of arms. The pair of claws bend towards each other in the closing direction and can cooperate with the action embedded in the sheath to grasp a portion of the clamp connected to the ring member and pull it into the sheath. When the pair of arms are submerged in the sheath and closed, the gap between the closest portions of the pair of claws has a predetermined value that prevents the ring member from slipping when a portion of the ring member is held between the pair of claws. In the opening and closing portion, the first claw portion of the claw portion, which is one of the pair of arms, bends from its base end with a predetermined diameter, and the second claw portion of the claw portion, which is the other arm, bends from its base end in a manner that is longer than the first claw portion and has a diameter that is larger than the predetermined diameter. When the claw portion is buried in the sheath, the pair of arms close by covering the first claw portion from the outside with the second claw portion, and the closest portion is formed between the tip of the first claw portion and the area between the tip of the second claw portion and the base end end.

2. The endoscopic treatment device according to claim 1, characterized in that, The specified value is below 0.15 mm.

3. The endoscopic treatment device according to claim 1, characterized in that, The opening and closing part is a connecting hook that can be disengaged from a medical clip used to hold tissues inside the body.

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