Traction clamp for endoscope

Abstract

In order to have a simple structure and enable a lesion to be stably and easily lifted, this endoscope traction jig (1A) is provided with: a jig main body (10) having a pair of arm parts (arm plate parts 30, 40) that expand in a substantially V-shape, and a loop-shaped tightening loop (50) that is slidably fitted over a connecting part on the base end side of the arm parts; and a ring member (100) which is attached to the jig body (10) and is formed in a ring shape. The ring member (100) is formed by connecting an elastic portion (P1) having elasticity that expands and contracts in the annular extension direction and a non-elastic portion (P2) having flexibility and non-elasticity that does not expand and contracts in the annular extension direction.

Description

Technical Field

[0001] The present invention relates to an endoscope traction clamp which is inserted into a body by an endoscope and used to traction a part of biological tissue including a lesion. Background Art

[0002] In endoscopic submucosal dissection (ESD), in order to facilitate the removal of the lesion and improve the reliability, the following operation is sometimes performed, that is, in order to prevent the peeled lesion from hindering the continued incision when a part of the lesion is incised and peeled, a traction force is applied to the lesion in advance, and the peeled lesion is lifted while the entire lesion is incised. As a clamp for lifting the lesion in ESD, for example, a medical clamp described in the following patent document 1 and an endoscopic traction clamp described in the following patent document 2 are known.

[0003] Patent Document 1 describes a medical clamp having an engaging portion having one or more loops mounted on a clamp body. Patent Document 2 describes an endoscope traction clamp having a plurality of rope-like loops supported by the clamp body, the rope-like loops traction the lesion toward the mucosa opposite to the lesion.

[0004] Prior art literature

[0005] Patent Literature

[0006] Patent document 1: Japanese Patent No. 4472680.

[0007] Patent document 2: Japanese Patent Application Publication No. 2022-62923. Summary of the invention

[0008] Problem that the invention aims to solve

[0009] The medical clamp described in Patent Document 1 and the endoscopic traction clamp described in Patent Document 2 both adopt a structure in which multiple independent loops (multiple rope-shaped rings) are installed on the clamp body, which leads to problems such as complex connection between the multiple loops and the clamp body and entanglement of the multiple loops with each other. In addition, it is not easy to transport (deliver) the multiple loops into the body, and the number of loops (i.e., the number of anchor points during traction) is naturally limited.

[0010] In addition, there is a problem that when multiple loops are attached to the lesion and multi-point traction is performed, the multiple loops all extend to the part opposite to the lesion (opposite part) during traction and become obstacles, thereby reducing the operability of the endoscope and the resection instrument of the lesion.

[0011] The present invention has been made in view of the above-mentioned problems, and an object of the present invention is to provide an endoscope traction clip having a simple structure and capable of stably and easily lifting a lesion.

[0012] Solutions for solving problems

[0013] In order to achieve the above-mentioned purpose, the traction clamp for endoscope of the present invention is characterized in that it comprises: a clamp body, which has a pair of arms opened in a roughly V-shape and a ring-shaped tightening ring slidably fitted on the connecting portion on the base end side of the arm; a ring member, which is installed on the clamp body and formed in a ring shape, and the ring member is composed of an elastic portion and a non-elastic portion connected, the elastic portion has elasticity that can be expanded and contracted in the direction extending in the ring shape, and the non-elastic portion has flexibility and has non-elasticity that does not expand and contract in the direction extending in the ring shape.

[0014] According to the above structure, an endoscope traction clamp having a simple structure in which a ring member having a partial elastic portion and a partial inelastic portion is mounted on a clamp body capable of grasping biological tissue, and a lesion can be stably lifted.

[0015] In the traction clamp for endoscope of the present invention, by installing the clamp body at a predetermined position near the lesion, and using another clamp to fix the non-elastic part at another position near the lesion, anchor points for traction can be determined at multiple positions (two or more points) near the lesion. By using the non-elastic part to determine the anchor point of the lesion, the traction force acting when lifting the lesion is reliably transmitted to the anchor point as the tension of the non-elastic part, and the lesion can be stably lifted.

[0016] Furthermore, since the two different points of the inelastic portion are located apart from each other due to the inelasticity of the inelastic portion, the two different points separated from each other in the inelastic portion can be easily and reliably determined as anchor points fixed near the lesion.

[0017] In addition, by further using another clamp to fix the elastic part to the part (opposite part) opposite to the lesion part, the lesion part can be lifted by its traction force (elastic force). The elastic part has elasticity that allows expansion and contraction, and when the periphery of the lesion part is cut and peeled off from the inner wall of the hollow organ, the lesion part can be lifted in a direction away from the inner wall of the hollow organ (opposite part direction), so that the peeled part generated after the lesion part is peeled off can be easily seen, and the lesion part is kept lifted, so that the whole periphery of the lesion part can be easily and reliably cut without hindering the operation.

[0018] The endoscope traction clip of the present invention may be configured such that, in the above-described structure, the non-elastic portion of the ring member is attached to the arm portion of the clip body.

[0019] According to the above configuration, a predetermined location of the attachment jig body near the lesion can be determined as one of the plurality of anchor points.

[0020] The endoscope traction jig of the present invention may be configured such that, in the above-described configuration, a portion of the non-elastic portion of the ring member is constituted by a non-elastic ring member formed in a ring shape.

[0021] According to the above configuration, by fixing the inelastic ring member near the lesion, the position where the inelastic ring member is provided can be easily and reliably determined as an anchor point fixed near the lesion.

[0022] Furthermore, when the inelastic ring member is fixed near the lesion using another clamp, the inelastic ring member can be easily fixed near the lesion by hooking and clamping the loop of the inelastic ring member with the arm of the other clamp.

[0023] The endoscope traction clamp of the present invention may also be a structure described above, wherein the inelastic portion of the ring member is composed of a flexible inelastic wire, and a first inelastic ring member and a second inelastic ring member formed in a ring shape at both ends of the inelastic wire, and the first inelastic ring member and the second inelastic ring member are respectively connected to the two ends of the elastic portion of the ring member.

[0024] According to the above configuration, by fixing the first and second inelastic ring members near the lesion by sandwiching them, the position where the first and second inelastic ring members are provided can be easily and reliably determined as an anchor point for fixing near the lesion.

[0025] Furthermore, by appropriately selecting any one or more points of the inelastic wire inserted between the first inelastic ring member and the second inelastic ring member and fixing them near the lesion, in addition to being able to determine the first inelastic ring member and the second inelastic ring member as anchor points, any point of the inelastic wire can also be determined as an anchor point, and a total of more than three anchor points can be pulled (multi-point traction) to stably lift the lesion.

[0026] In the endoscope traction jig of the present invention, in the above-mentioned configuration, the elastic portion of the ring member may be composed of an elastic ring member formed in a ring shape.

[0027] According to the above structure, after multiple anchor points are determined near the lesion, when another clamp is used to further fix the elastic part to a part (relative part) opposite to the lesion, the elastic ring member can be easily fixed to the relative part by hooking and clamping the ring of the elastic ring member with the arm of the other clamp.

[0028] The traction clip for an endoscope of the present invention may be configured as follows: in the above-mentioned configuration, a connecting member for connecting at least one of the pair of arm portions of the clip body and the elastic portion may be provided.

[0029] According to the above configuration, the pulling force of the elastic portion is reliably transmitted to the anchor point determined by the clip body via the connecting member, and the lesion can be stably lifted.

[0030] The endoscope traction jig of the present invention may be configured such that, in the above-described configuration, a non-elastic ring member formed in a ring shape is attached to a part of the elastic portion of the ring member.

[0031] According to the above structure, after multiple anchor points are determined near the lesion, when another clamp is used to further fix the elastic part to a part (relative part) opposite to the lesion, the elastic ring member can be easily fixed to the relative part by hooking and clamping the annular non-elastic ring member installed on a part of the elastic part of the ring member with the arm of the other clamp.

[0032] In the endoscope traction jig of the present invention, in the above-mentioned structure, the elastic portion may be formed of an elastic molded component, and the inelastic portion may be formed of a wire material using natural fiber or chemical fiber.

[0033] According to the above configuration, the endoscope traction clamp of the present invention can be easily manufactured by manufacturing a ring member formed by connecting an elastic molded component and a wire material using natural fibers or chemical fibers, and attaching the ring member to the clamp body. BRIEF DESCRIPTION OF THE DRAWINGS

[0034] Figure 1 This is a perspective view showing the entire structure of the traction clip for an endoscope according to the first embodiment of the present invention, and is a view showing a state in which the arm plate portion of the clip body is opened.

[0035] Figure 2 yes Figure 1 A front view of the endoscope traction clamp is shown.

[0036] Figure 3 It is shown in Figure 1 The figure shows a state in which the arm plate parts of the clamp body of the endoscope traction clamp are closed.

[0037] Figure 4 This is a diagram showing the appearance of a clip device used when the traction clip for an endoscope according to the first embodiment of the present invention is transported into the body.

[0038] Figure 5 It is along Figure 4 Cross-sectional view of the Va-Va line.

[0039] Figure 6 It is shown Figure 4 A three-dimensional view of a connecting hook of a clamp device and its surrounding structures is shown.

[0040] Figure 7 This is a diagram showing a state in which the endoscope traction clip according to the first embodiment of the present invention is protruded from the distal end of the clip device.

[0041] Figure 8 This is a diagram showing a state in which the endoscope traction clip according to the first embodiment of the present invention is accommodated in the distal end portion of the clip device.

[0042] Fig. 9 This is a diagram schematically showing the periphery of a lesion that is a target for peeling and resection using the endoscopic traction clip according to the first embodiment of the present invention.

[0043] Fig.10 This is a diagram schematically showing a state in which the clip body of the endoscopic traction clip according to the first embodiment of the present invention is attached to a lesion.

[0044] Fig.11 This is a diagram schematically showing a state in which the second inelastic ring member of the endoscope traction jig according to the first embodiment of the present invention is attached to a lesion using the first jig.

[0045] Fig.12 This is a diagram schematically showing a state in which the anchor wire of the traction jig for an endoscope according to the first embodiment of the present invention is attached to a lesion using a second jig.

[0046] Fig.13 This is a diagram schematically showing a state in which the elastic ring member of the endoscope traction jig according to the first embodiment of the present invention is attached to a portion facing a lesion using a third jig.

[0047] Fig.14 It is schematically shown from Fig.13 The state shown is a diagram of a state in which the periphery of the lesion is cut and the lesion is lifted.

[0048] Fig.15 It is schematically shown from Fig.14 The state shown is a diagram in which the lesion has been removed.

[0049] Fig.16 It is a perspective view showing the entire structure of the traction clip for an endoscope according to the second embodiment of the present invention, and is a view showing a state in which the arm plate portion of the clip body is opened.

[0050] Fig.17 yes Fig.16 A front view of the endoscope traction clamp is shown.

[0051] Fig.18 This is a diagram showing a state in which the traction clip for an endoscope according to the second embodiment of the present invention is made to protrude from the distal end of the clip device.

[0052] Fig.19 This is a diagram showing a state in which the endoscope traction clip according to the second embodiment of the present invention is accommodated in the distal end portion of the clip device.

[0053] Fig. 20 This is a diagram schematically showing a state in which a clip body of an endoscope traction clip according to a second embodiment of the present invention is attached to a lesion.

[0054] Fig.21 This is a diagram schematically showing a state in which the first inelastic ring member of the traction jig for an endoscope according to the second embodiment of the present invention is attached to a lesion using the first jig.

[0055] Fig. 22 This is a diagram schematically showing a state in which the second inelastic ring member of the traction jig for an endoscope according to the second embodiment of the present invention is attached to a lesion using the second jig.

[0056] Fig.23 It is a diagram schematically showing a state in which the traction ring member of the elastic ring member of the traction jig for an endoscope according to the second embodiment of the present invention is attached to a portion facing a lesion using a third jig.

[0057] Fig.24 It is schematically shown from Fig.23 The state shown is a diagram of a state in which the periphery of the lesion is cut and the lesion is lifted.

[0058] Fig.25 This is a front view showing a first modified example of the traction clip for an endoscope according to the present invention.

[0059] Fig.26 It is a front view showing a second modified example of the traction clip for an endoscope according to the present invention.

[0060] Fig. 27 It is a front view showing a third modified example of the traction clip for an endoscope according to the present invention.

[0061] Fig.28 It is a perspective view showing a fourth modified example of the traction clip for an endoscope according to the present invention, and is a view showing a state in which the arm plate portion of the clip body is opened.

[0062] Fig.29 This is a diagram schematically showing a state in which the anchor wire of the traction clip for an endoscope is attached to a lesion using the first clip and the second clip in the fourth modification of the traction clip for an endoscope of the present invention. DETAILED DESCRIPTION

[0063] Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings. In this specification, the operator who performs ESD surgery using the endoscopic traction clamp of the present invention is used as a reference, the inner side of the patient's body is set as the distal side, and the front side of the operator is set as the proximal side. The drawings referred to in this specification may not have an accurate scale relative to the actual size, but are partially enlarged or simplified figures in order to schematically illustrate the structure of the present invention.

[0064] (First embodiment)

[0065] A description will be given of an endoscope traction clip 1A according to a first embodiment of the present invention.

[0066] (Structure of endoscope traction clamp 1A)

[0067] Figure 1 1A is a perspective view showing the overall structure of the endoscope traction clip 1A according to the first embodiment of the present invention, and is a view showing a state in which the arm plates 30 and 40 of the clip body 10 are opened. Figure 2 yes Figure 1 The front view of the endoscope traction clamp 1A is shown. Figure 3 It is shown in Figure 1 The illustrated diagram shows a state in which the arm plates 30 and 40 of the clamp body 10 of the endoscope traction clamp 1A are closed.

[0068] The endoscope traction clip 1A according to the first embodiment is roughly configured to include a clip body 10 and a ring member 100 .

[0069] The clamp body 10 includes a connecting plate portion (connecting portion) 20, a pair of arm plate portions (arm portions) 30, 40, and a tightening ring 50. The connecting plate portion 20 has a shape bent into a substantially U-shape, and the arm plate portions 30, 40 are integrally formed with each end of the U-shape so as to be continuous and open in a substantially V-shape toward the tip end thereof.

[0070] The tightening ring 50 is a ring-shaped member that is slidably fitted to the connecting plate portion 20 on the base end side of the arm plate portions 30 and 40. As described later, the tightening ring 50 is formed by using a clamp device (for details, refer to Figures 4 to 6The clamp device has an inner sheath (sheath tube) 62 and a connecting hook (engaging member) 61 detachably connected (engaged) to the connecting plate portion 20, and the connecting hook 61 is configured to be able to move forward and backward relative to the inner sheath 62. When the connecting hook 61 is connected to the connecting plate portion 20, the connecting hook 61 is pulled in from the top end of the inner sheath 62, so that the tightening ring 50 is pushed by the top end of the inner sheath 62 and slides toward the top end side (distal end side) of the pair of arm plate portions 30, 40, so that the pair of arm plate portions 30, 40 are closed.

[0071] Claws 32 and 42 are formed integrally at the top of each arm plate 30 and 40. The claws 32 and 42 are formed by bending the top of each arm plate 30 and 40 inward (ie, in the closing direction). The claws 32 and 42 have recessed notches 32a and 42a at the middle of the top.

[0072] The connecting plate portion 20, the arm plate portions 30, 40, and the claw portions 32, 42 constituting the clamp body 10 are formed by bending a thin and elongated plate. The plate thickness of the plate constituting the clamp body 10 is not particularly limited, but is preferably 0.10 to 0.30 mm. As the plate constituting the clamp body 10, a plate having elasticity, such as stainless steel, is preferably used.

[0073] like Figure 1 As shown, a pair of arm plate parts 30, 40 respectively have base end parts 30p, 40p and gripping parts 30g, 40g. Through parts 31, 41 are formed in the gripping parts 30g, 40g of each arm plate part 30, 40, respectively. These through parts 31, 41 are formed so as not to impair the desired strength of the arm plate parts 30, 40 (gripping parts 30g, 40g). One of these through parts 31, 41 is used to mount the ring member 100 on the clamp body 10. Here, the through part 31 formed in the gripping part 30g of the arm plate part 30 is used to connect the clamp body 10 and the ring member 100.

[0074] The tightening ring 50 is slidably embedded in the connecting plate portion 20. The tightening ring 50 is composed of a roughly cylindrical ring member. However, the tightening ring 50 can also be composed of a spring formed by winding a wire into a coil. The tightening ring 50 has the connecting plate portion 20 inserted into the guide hole on the inner side thereof, and is assembled (outer-embedded) in a manner that allows it to move (slide) axially between the outer periphery of the connecting plate portion 20 and the outer periphery of the base end portions 30p, 40p of the arm plate portions 30, 40.

[0075] like Figure 1 and Figure 2As shown, when the tightening ring 50 is arranged at the base end side of the clamp body 10 (the position close to the connecting plate 20), the pair of arm plates 30 and 40 are in a state of being opened by their own elasticity (the arm plates 30 and 40 are in a state of being opened). Figure 3 By moving (sliding) the tightening ring 50 toward the distal end of the clamp body 10 (close to the gripping portions 30g and 40g) in the direction of arrow D1, the pair of arm plates 30 and 40 can be closed (closed) to grip biological tissue.

[0076] The ring member 100 is a member that is mounted on the clamp body 10 and is formed in an annular shape. The ring member 100 is formed by connecting an elastic portion P1 and a non-elastic portion P2, wherein the elastic portion P1 has elasticity that expands and contracts in a direction extending in an annular shape (hereinafter referred to as the annular extension direction), and the non-elastic portion P2 has flexibility and has non-elasticity that does not expand and contract in the annular extension direction. That is, the ring member 100 is a member that is formed in an annular shape, and adopts a structure that partially has the elastic portion P1 and partially has the non-elastic portion P2 in the annular extension direction.

[0077] In the first embodiment, the elastic portion P1 of the ring member 100 is composed of an elastic ring member 110 formed into a ring shape. The elastic ring member 110 is preferably composed of an elastic body molded part made of an elastic body having elasticity (rubber elasticity) for expansion and contraction. The elastic body molded part can be obtained by, for example, cross-linking a rubber polymer or melt-molding a thermoplastic elastomer. In addition, as the elastic ring member 110, for example, a medical rubber band with a diameter of about 3 to 10 mm used in dental correction treatment, i.e., an intermaxillary rubber band, can be used. An intermaxillary rubber band is used for the elastic ring member 110 of the first embodiment.

[0078] In the first embodiment, the inelastic portion P2 of the ring member 100 is composed of an anchor wire 120, a first inelastic ring member 130, and a second inelastic ring member 140. The anchor wire 120 is composed of a wire having flexibility and not stretching in the ring extension direction. The first inelastic ring member 130 and the second inelastic ring member 140 are respectively connected to both ends of the anchor wire 120 and are also composed of a wire having flexibility and not stretching in the ring extension direction. The first inelastic ring member 130 and the second inelastic ring member 140 are annular members that are not connected to each other but have independent rings, and are respectively connected to both ends of the anchor wire 120 and are respectively connected to the elastic ring member 110 constituting the elastic portion P1 of the ring member 100.

[0079] The anchor wire 120 is composed of a wire that is flexible and can be bent flexibly on the one hand, and a non-elastic wire that does not stretch relative to its extension direction on the other hand (an inelastic wire that does not have rubber elasticity). As a material for the anchor wire 120, wires made of, for example, silk, nylon, polyester, polypropylene, stainless steel, titanium, etc. can be used. As an example, a surgical suture made of natural fiber or chemical fiber can be used. A surgical suture made of nylon is used for the anchor wire 120 of the first embodiment.

[0080] As described later, the anchor wire 120 is used to determine the anchor point when traction is performed to lift the lesion. The length of the anchor wire 120 can be appropriately set according to the type and size of the hollow organ in the body where the lesion is located, and can be set to a length that is longer than half the loop length of the elastic ring member 110 constituting the elastic part P1 and shorter than the loop length.

[0081] The first inelastic ring member 130 and the second inelastic ring member 140 are composed of a wire material (inelastic wire material without rubber elasticity) that is flexible and can be bent flexibly on the one hand and does not stretch relative to its extension direction on the other hand. As the material of the first inelastic ring member 130 and the second inelastic ring member 140, wire materials such as silk, nylon, polyester, polypropylene, stainless steel, titanium, etc. can be used, as with the anchor wire 120. As an example, surgical sutures using natural fibers or chemical fibers can be used. Here, surgical sutures made of silk are used for the first inelastic ring member 130, and surgical sutures made of nylon are used for the second inelastic ring member 140.

[0082] As described later, the first inelastic ring member 130 and the second inelastic ring member 140 are used to determine the anchor point when traction is performed to lift the lesion. The ring lengths of the first inelastic ring member 130 and the second inelastic ring member 140 can be appropriately set according to the type and size of the hollow organ in the body where the lesion is located, and can be set to, for example, about half the length of the elastic ring member 110 constituting the elastic portion P1. The ring lengths of the first inelastic ring member 130 and the second inelastic ring member 140 can be the same or different.

[0083] The first inelastic ring member 130 and the second inelastic ring member 140 are respectively connected to both ends of the anchor wire 120. That is, the anchor wire 120 is inserted between the first inelastic ring member 130 and the second inelastic ring member 140. The method of connecting the anchor wire 120 to the first inelastic ring member 130 and the second inelastic ring member 140 is not particularly limited, for example, the ends of the anchor wire 120 may be fixed to the wires constituting the first inelastic ring member 130 and the second inelastic ring member 140, respectively, or may be formed integrally.

[0084] In addition, the first inelastic ring member 130 and the second inelastic ring member 140 are connected to both ends of the elastic part P1, respectively. In the first embodiment, the elastic ring member 110 constituting the elastic part P1 is inserted between the first inelastic ring member 130 and the second inelastic ring member 140. The connection method of the elastic part P1, the first inelastic ring member 130 and the second inelastic ring member 140 is not particularly limited. The elastic part P1 of the first embodiment is an elastic ring member 110 formed in a ring shape. By making the ring formed by the elastic ring member 110 and the ring formed by the first inelastic ring member 130 pass through each other and associate, the elastic ring member 110 can be connected to the first inelastic ring member 130. Similarly, by making the ring formed by the elastic ring member 110 and the ring formed by the second inelastic ring member 140 pass through each other and associate, the elastic ring member 110 can be connected to the second inelastic ring member 140. In other words, the first inelastic ring member 130 , the elastic ring member 110 , and the second inelastic ring member 140 are connected in a chain-like structure.

[0085] In addition, the elastic ring member 110 and the first inelastic ring member 130 and the second inelastic ring member 140 may be fixed to each other, or may be free to move freely relative to each other. Here, the elastic ring member 110 and the first inelastic ring member 130 and the second inelastic ring member 140 are associated and connected in a state where the rings are free from each other.

[0086] In this way, the elastic ring member 110 of the elastic portion P1, the first inelastic ring member 130 constituting the inelastic portion P2, the anchor wire 120, and the second inelastic ring member 140 are connected in an annular shape to form a ring, thereby constituting the ring member 100.

[0087] The ring member 100 is mounted on the arm plate portions 30 and 40 of the clamp body 10. For example, any one of the first inelastic ring member 130 and the second inelastic ring member 140 can be mounted on any one of the arm plate portions 30 and 40 of the clamp body 10. Figure 1As shown, the first inelastic ring member 130 is attached to the arm plate portion 30 of the clamp body 10 by inserting the ring formed by the first inelastic ring member 130 into the through portion 31 formed in the gripping portion 30g of the arm plate portion 30 to associate them. In addition, the first inelastic ring member 130 and the arm plate portion 30 may be fixed to each other, or may be free in a manner that allows them to move freely relative to each other. Here, the first inelastic ring member 130 and the arm plate portion 30 are in a state where the ring formed by the first inelastic ring member 130 is inserted into the through portion 31 of the arm plate portion 30 but is free from each other.

[0088] (Structure of the clamp device 60)

[0089] The endoscope traction clip 1A of the first embodiment is mounted and housed in the distal end portion (distal end portion) of the clip device 60 , and the sheath portion of the clip device 60 is inserted into the lumen of the endoscope and guided to the biological tissue to be treated.

[0090] Below, while referring to Figures 4 to 6 , an example of a clamp device 60 used when the traction clamp 1A for an endoscope is transported into the body will be described. Figure 4 This is a diagram showing the appearance of a clip device 60 used when the traction clip 1A for an endoscope according to the first embodiment of the present invention is transported into the body. Figure 5 It is along Figure 4 Cross-sectional view of the Va-Va line. Figure 6 It is shown Figure 4 The illustrated diagram is a perspective view of a connecting hook 61 of a clamp device 60 and its surrounding structures.

[0091] like Figure 4 As shown, the clamp device 60 is roughly configured to include a connecting hook 61 , an inner sheath 62 , a driving wire 63 , an outer sheath 64 , a reinforcing coil 65 , a slider 66 , a base 67 , and an operating portion 68 .

[0092] like Figure 5 As shown, a tubular inner sheath 62 of the same tubular shape is inserted into an outer sheath 64, and a driving wire 63 is inserted into the inner sheath 62. The inner sheath 62 can slide in the outer sheath 64, and the driving wire 63 can slide in the inner sheath 62.

[0093] The outer sheath 64 is composed of a flexible hollow tube, and a coil, for example, can be used. As the coil, a flat wire coil formed by winding a long flat plate formed of metal (stainless steel) or the like 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 end of the outer sheath 64 is about 2 to 3 mm.

[0094] The inner sheath 62 is composed of a flexible hollow tube, and a wire tube, for example, can be used. The wire tube is a tube formed of a hollow stranded wire, and the hollow stranded wire is formed by twisting a plurality of wires (cables) formed of, for example, metal (stainless steel) into a spiral shape in a hollow manner. In addition, as the inner sheath 62, the following components can also be used, that is, the wire tube is mainly used, and only a part of the top end side thereof is used as a coil. The inner diameter of the top end portion of the inner sheath 62 is about 1.5 to 2.5 mm.

[0095] The driving wire 63 is made of a flexible wire, and a steel wire rope can be used, for example. The steel wire rope is a rope formed of a stranded wire, and the stranded wire is formed by twisting a plurality of wires (cables) made of, for example, metal (stainless steel) into a spiral shape. However, as the driving wire 63, a steel wire hose can also be used in the same manner as the inner sheath 62.

[0096] like Figure 6 As shown, the connecting hook 61 disposed at the tip of the sheath tube of the clamp device 60 has a pair of arm portions 61a, 61b formed of an elastic body disposed in a substantially V-shape toward the tip thereof, and can obtain two states of an open (open) state and a closed (closed) state by cooperating with the inner sheath 62. At the tip of the arm portions 61a, 61b of the connecting hook 61, claw portions 61a1, 61b1 are formed by bending inward (on the sides facing each other), and can grasp the connecting plate portion 20 of the clamp body 10 for connection.

[0097] The base end of the connecting hook 61 is a U-shaped portion 61c which is continuous with the base ends of the pair of arm portions 61a and 61b and is formed into a substantially U-shaped shape. The arm portions 61a and 61b and the U-shaped portion 61c including the claw portions 61a1 and 61b1 can be formed by appropriately bending (plastically deforming) a thin and long plate made of an elastic body. Although not particularly limited, the plate thickness of the plate constituting the connecting hook 61 is about 0.20 to 0.24 mm and the width is about 0.6 mm. As the plate, for example, stainless steel is used.

[0098] A substantially annular ring member 63a is integrally welded and fixed to the distal end (distal end) of the driving wire 63 slidably inserted into the inner sheath 62 by laser welding or the like. The outer diameter of the annular ring member 63a is about 1.2 mm, and the inner diameter is about 0.8 to 1.0 mm.

[0099] The connecting hook 61 is inserted into the circular ring member 63a and is arranged in such a manner that the U-shaped portion 61c is loosely fitted in the circular ring member 63a, so as to be swingably mounted on the distal end of the driving wire 63. By mounting the connecting hook 61 on the distal end of the driving wire 63 via such a circular ring member 63a and the U-shaped portion 61c loosely fitted in the circular ring member 63a, the connecting hook 61 can be mounted on the distal end of the driving wire 63. Figure 6It can rotate freely in the direction of arrow D2 shown.

[0100] Back to Figure 4 and Figure 5 The vicinity of the proximal end (proximal end) side of the outer sheath 64 is inserted into the reinforcing coil 65 and integrally fixed to the reinforcing coil 65. The reinforcing coil 65 is integrally fixed to the slider 66, and the distal end side portion of the base 67 is inserted and arranged inside the slider 66. The slider 66 slides between two positions, a position moved to the distal end side and a position moved to the proximal end (proximal end) side, in a manner that allows positioning relative to the base 67.

[0101] The operation portion 68 is slidably held on the base portion 67, and the inner sheath 62 is fixed to the base portion 67. The base end of the driving wire 63 is fixed to the operation portion 68.

[0102] When the operation part 68 is slid toward the distal end side (distal end side) relative to the base part 67, the driving wire 63 is pushed out relative to the inner sheath 62, and the connecting hook 61 at the distal end of the driving wire 63 protrudes from the distal end of the inner sheath 62 and opens due to its own elasticity. When the operation part 68 is slid toward the proximal end side (proximal end side) relative to the base part 67, the driving wire 63 is pulled in relative to the inner sheath 62, and the connecting hook 61 at the distal end of the driving wire 63 gradually closes while entering the inner sheath 62, and is completely closed by being immersed in the inner sheath 62.

[0103] When the slider 66 is slid toward the proximal side relative to the base 67, the inner sheath 62 can protrude from the distal end of the outer sheath 64. Conversely, when the slider 66 is slid toward the distal side relative to the base 67, the distal end of the inner sheath 62 can be accommodated (received) in the outer sheath 64.

[0104] (How to use the endoscope traction clamp 1A)

[0105] Next, a method of using the endoscope traction clip 1A according to the first embodiment will be described. Figure 7 1A is a diagram showing a state in which the endoscope traction clip 1A according to the first embodiment is protruded from the distal end of the clip device 60. Figure 8 This is a diagram showing a state in which the endoscope traction clip 1A according to the first embodiment is accommodated in the distal end portion of the clip device 60 .

[0106] In the clamp body 10, a tightening ring 50 is fitted around the outer periphery of the connecting plate portion 20 and near the base end portions 30p and 40p, and a connecting hole 25 (see Figure 2 and Figure 7 ). Figure 4 The connecting hook 61 shown is engaged with the connecting hole 25, and the connecting hook 61 is pulled into the interior of the inner sheath 62, whereby the connecting hook 61 is closed, as shown in FIG. Figure 7 As shown, the clip body 10 of the endoscope traction clip 1A is attached to the distal end portion of the inner sheath 62 .

[0107] In this state, the distal end portion of the inner sheath 62 to which the endoscope traction jig 1A (the jig body 10 and the ring member 100) is connected is pulled into the outer sheath 64. Figure 8 As shown in the figure, the endoscope traction clamp 1A (clamp body 10 and ring member 100) is entirely accommodated inside the distal end portion of the outer sheath 64. In this state, the tightening ring 50 of the clamp body 10 is kept located at the connecting plate portion 20, and the arm plate portions 30 and 40 are closed by the action of the inner wall of the outer sheath 64. In addition, the elastic ring member 110, the anchor wire 120, the first inelastic ring member 130, and the second inelastic ring member 140 constituting the ring member 100 are accommodated in the outer sheath 64. The elastic ring member 110 is accommodated in the outer sheath 64 in an elastically deformed state by the action of the inner wall of the outer sheath 64.

[0108] Using an endoscope (not shown), the tip of the sheath tube (inner sheath 62 and outer sheath 64) of the clamp device 60 equipped with the endoscope traction clamp 1A is positioned near the lesion to be incised (stripped). In this specification, the vicinity of the lesion refers to the range including the lesion and its surroundings. Next, the endoscope traction clamp 1A is protruded from the distal end of the outer sheath 64 by sliding the outer sheath 64 toward the base end. Figure 7 As shown, the elastic ring member 110, the anchor wire 120, the first inelastic ring member 130, and the second inelastic ring member 140 constituting the ring member 100 are released to the outside of the outer sheath 64, and the arm plate portions 30 and 40 are in a state of being opened by their own elasticity. The elastic ring member 110 returns to its original shape from the state of being elastically deformed by the action of the inner wall of the outer sheath 64.

[0109] When the arm plates 30 and 40 are open, the inner sheath 62 slides toward the distal end relative to the drive wire 63, so that the tightening ring 50 slides toward the distal end of the arm plates 30 and 40. As a result, the arm plates 30 and 40 gradually close (approach each other), and the arm plates 30 and 40 can grasp the biological tissue.

[0110] By sliding the inner sheath 62 further toward the distal end relative to the driving wire 63, the tightening ring 50 moves toward the gripping portions 30g and 40g of the arm plate portions 30 and 40 (see Figure 3). Thus, the biological tissue is grasped by the clamp body 10. In this state, the inner sheath 62 is slid toward the base end relative to the drive wire 63, so that the connecting hook 61 is pushed out from the distal end of the inner sheath 62 and opens, and the grip (engagement) of the clamp body 10 by the connecting hook 61 is released, and the endoscope traction clamp 1A is released, and the biological tissue is grasped by the endoscope traction clamp 1A.

[0111] (Method of peeling off a lesion using the traction clip 1A for an endoscope)

[0112] Below, while referring to Figures 9 to 15 , a method for peeling off a lesion using the traction clip 1A for an endoscope according to the first embodiment will be described. Figures 9 to 15 The diagram schematically shows each step of the lesion peeling method using the traction clip 1A for an endoscope according to the first embodiment.

[0113] The endoscope traction clamp 1A of the first embodiment is used to peel and remove a lesion on the inner wall of a hollow organ in the body by ESD. Fig. 9 As shown, the case of peeling and resecting the mucosa (biological tissue) including the lesion X generated in the large intestine wall W will be described. The endoscope traction clip 1A of this embodiment can be applied not only to the large intestine but also to hollow organs such as the esophagus, stomach, and duodenum.

[0114] The tip of the endoscope (not shown) is positioned near the lesion X through the mouth or nose. Then, the tip of the sheath tube of the clamp device 60 equipped with the endoscope traction clamp 1A is inserted into the body using the tip of the endoscope, and positioned near the lesion X to be treated by incision (peeling). Next, the outer sheath 64 is slid toward the base end side, so that the endoscope traction clamp 1A protrudes from the distal end of the outer sheath 64, the arm plates 30 and 40 are in a state of being opened by their own elasticity, and the elastic ring member 110, the anchor wire 120, the first inelastic ring member 130, and the second inelastic ring member 140 constituting the ring member 100 are deployed near the lesion X.

[0115] With the arm plates 30 and 40 open, the clamp body 10 of the endoscope traction clamp 1A is positioned near the lesion X. The clamp body 10 is preferably disposed at a position where it can grip a portion near the periphery of the lesion X (for example, the right end of the lesion X).

[0116] Next, while pressing the clamp body 10 against the desired position of the lesion X (for example, the right end of the lesion X), the inner sheath 62 is slid toward the distal end relative to the driving wire 63, so that the tightening ring 50 slides toward the distal end of the arm plate parts 30 and 40. As a result, the arm plate parts 30 and 40 gradually close (approach each other) and can grasp the lesion X (the right end of the lesion X). By further sliding the inner sheath 62 toward the distal end relative to the driving wire 63, the tightening ring 50 moves toward the grasping parts 30g and 40g of the arm plate parts 30 and 40, and the lesion X is grasped by the clamp body 10 of the endoscope traction clamp 1A.

[0117] In this state, the inner sheath 62 is slid toward the proximal end relative to the driving wire 63, so that the connecting hook 61 is pushed out from the distal end of the inner sheath 62 and opened, and the grip (engagement) of the clamp body 10 by the connecting hook 61 is released, and the endoscope traction clamp 1A is released, and the clamp body 10 of the endoscope traction clamp 1A is clamped on the lesion X ( Fig.10 status shown).

[0118] As described above, the loop of the first inelastic ring member 130 is inserted into the through portion 31 of one arm plate portion 30 of the clamp body 10. Therefore, a part of the wire material constituting the first inelastic ring member 130 is fixed to the lesion X grasped by the clamp body 10. The portion where the wire material constituting the first inelastic ring member 130 is fixed to the lesion X functions as an anchor point A1 when the lesion X is pulled as described later.

[0119] Next, the clamp device 60 is temporarily pulled out of the endoscope, and then another clamp (first clamp) 10A prepared separately is attached to the distal end of the clamp device 60 (or a clamp device prepared separately having the same structure as the clamp device 60), and the distal end of the sheath tube portion of the clamp device 60 attached with the first clamp 10A is inserted into the body so as to be located near the lesion X. In addition, as the first clamp 10A, a clamp having the same structure as that of the endoscope can be used. Figure 1 to Figure 3 The illustrated endoscope traction clip 1A is an endoscope clip having the same structure as the clip body 10 except that the ring member 100 is removed.

[0120] Next, similarly to the clamp body 10 of the endoscope traction clamp 1A, the first clamp 10A is protruded from the distal end of the outer sheath 64, and the pair of arm plates 30A and 40A of the first clamp 10A are opened by their own elasticity. Then, one of the pair of arm plates 30A and 40A of the first clamp 10A is hooked on the ring of the second inelastic ring member 140, and one of the arm plates 30A and 40A is inserted into the ring of the second inelastic ring member 140, and the first clamp 10A is arranged at a position where it can grasp a different part (for example, the left end of the lesion X) from the already arranged clamp body 10.

[0121] Next, similar to the gripping by the clamp body 10 of the endoscope traction clamp 1A, the first clamp 10A is pressed against the desired position of the lesion X (for example, the left end of the lesion X), and the tightening ring 50A is slid toward the tip side of the arm plate parts 30A and 40A, so that the lesion X (the left end of the lesion X) is gripped by the first clamp 10A. Then, by releasing the first clamp 10A, the gripping of the lesion X by the first clamp 10A is completed ( Fig.11 status shown).

[0122] As described above, one of the arm plates 30A and 40A of the first clamp 10A is inserted into the loop of the second inelastic ring member 140, and the arm plates 30A and 40A sandwich and grasp the wire constituting the second inelastic ring member 140 together with the lesion X. As a result, a part of the wire constituting the second inelastic ring member 140 is fixed to the lesion X grasped by the first clamp 10A. The part where the wire constituting the second inelastic ring member 140 is fixed to the lesion X functions as an anchor point A2 when the lesion X is pulled as described later.

[0123] Next, the clamp device 60 is temporarily pulled out of the endoscope, and then another clamp (second clamp) 10B prepared separately is attached to the distal end of the clamp device 60 (or a clamp device prepared separately having the same structure as the clamp device 60), and the distal end of the sheath portion of the clamp device 60 equipped with the second clamp 10B is inserted into the body so as to be located near the lesion X. In addition, as the second clamp 10B, a clamp having the same structure as the first clamp 10A can be used. Figure 1 to Figure 3 The illustrated endoscope traction clip 1A is an endoscope clip having the same structure as the clip body 10 except that the ring member 100 is removed.

[0124] Next, similarly to the clamp body 10 and the first clamp 10A of the endoscope traction clamp 1A, the second clamp 10B is protruded from the distal end of the outer sheath 64, and the pair of arm plates 30B and 40B of the second clamp 10B are opened by their own elasticity. Then, the anchor wire 120 is hooked by one of the pair of arm plates 30B and 40B of the second clamp 10B, and the anchor wire 120 is sandwiched by the arm plates 30B and 40B, and the second clamp 10B is arranged at a position where it can grasp a different part (for example, the front part of the lesion X) from the already arranged clamp body 10 and the first clamp 10A.

[0125] Next, similar to the gripping performed by the clamp body 10 and the first clamp 10A of the endoscope traction clamp 1A, the second clamp 10B is pressed against the desired portion of the lesion X (for example, the front portion of the lesion X), and the tightening ring 50B is slid toward the tip side of the arm plate parts 30B and 40B, so that the lesion X (the front portion of the lesion X) is gripped by the second clamp 10B. Then, by releasing the second clamp 10B, the gripping of the lesion X by the second clamp 10B is completed ( Fig.12 status shown).

[0126] As described above, the arm plates 30B and 40B of the second clamp 10B are in a state of sandwiching the anchor wire 120, and the arm plates 30B and 40B sandwich and grasp the anchor wire 120 together with the lesion X. As a result, a part of the anchor wire 120 is fixed to the lesion X grasped by the second clamp 10B. In addition, the position of the anchor wire 120 sandwiched by the second clamp 10B is not particularly limited, but it is preferable to sandwich the central part of the anchor wire 120 (the part separated from the first inelastic ring member 130 and the second inelastic ring member 140 by substantially the same distance). The part where the anchor wire 120 is fixed to the lesion X functions as an anchor point A3 when the lesion X is pulled as described later.

[0127] Next, the clamp device 60 is temporarily pulled out from the endoscope, and then another clamp (third clamp) 10C prepared separately is attached to the top end of the clamp device 60 (or a clamp device prepared separately having the same structure as the clamp device 60), and the top end of the sheath tube portion of the clamp device 60 equipped with the third clamp 10C is inserted into the body so that it is located near an appropriate portion (opposite portion) Y opposite to the lesion X. The opposite portion Y is, for example, the inner wall of a hollow organ opposite to the lesion X in the hollow organ. In addition, as the third clamp 10C, a clamp having the same structure as the first clamp 10A and the second clamp 10B can be used. Figure 1 to Figure 3 The illustrated endoscope traction clip 1A is an endoscope clip having the same structure as the clip body 10 except that the ring member 100 is removed.

[0128] Next, similarly to the clamp body 10, the first clamp 10A, and the second clamp 10B of the endoscope traction clamp 1A, the third clamp 10C is protruded from the distal end of the outer sheath 64, and the pair of arm plates 30C and 40C of the third clamp 10C are opened by their own elasticity. Then, one of the pair of arm plates 30C and 40C of the third clamp 10C is hooked on the loop of the elastic ring member 110, and one of the arm plates 30C and 40C is inserted into the loop of the elastic ring member 110, and the third clamp 10C is arranged at a position where it can grip the opposing part Y.

[0129] Next, the lesion X is lifted while the elastic ring member 110 is stretched, and the third clamp 10C is pressed against the portion Y opposite to the lesion X, while the tightening ring 50C is slid toward the top end of the arm plate portions 30C and 40C, so that the portion Y opposite to the lesion X is grasped by the third clamp 10C. Then, by releasing the third clamp 10C, the portion Y opposite to the lesion X is grasped by the third clamp 10C ( Fig.13 status shown).

[0130] As described above, one of the arm plates 30C and 40C of the third clamp 10C is inserted into the elastic ring member 110, and the arm plates 30C and 40C sandwich and grasp a part of the elastic ring member 110 together with the corresponding part Y of the lesion X. As a result, a part of the elastic ring member 110 is fixed to the corresponding part Y of the lesion X grasped by the third clamp 10C.

[0131] exist Fig.13 In the illustrated state, a force (traction force) that pulls the lesion X in the direction of the opposing site Y by its elastic force (tension) acts on the elastic ring member 110 .

[0132] The first inelastic ring member 130 connected to the elastic ring member 110 is fixed to the lesion X (the right end of the lesion X) through the clamp body 10. The fixing point of the first inelastic ring member 130 with respect to the lesion X functions as an anchor point A1 for lifting the lesion X by the traction force of the elastic ring member 110. In addition, the first inelastic ring member 130 is made of a material that does not expand or contract in the traction direction, and thus the traction force of the elastic ring member 110 can be reliably transmitted.

[0133] The second inelastic ring member 140 connected to the elastic ring member 110 is fixed to the lesion X (the left end of the lesion X) by the first clamp 10A. The fixing point of the second inelastic ring member 140 with respect to the lesion X functions as an anchor point A2 for lifting the lesion X by the traction force of the elastic ring member 110. In addition, the second inelastic ring member 140 is made of a material that does not expand or contract in the traction direction, and thus the traction force of the elastic ring member 110 can be reliably transmitted.

[0134] The anchor wire 120 is fixed to the lesion X (the central part in front of the lesion X) by the second clamp 10B. Both ends of the anchor wire 120 are connected to the first inelastic ring member 130 and the second inelastic ring member 140, and the traction force of the elastic ring member 110 is transmitted through at least one or both of the first inelastic ring member 130 and the second inelastic ring member 140. Thus, the fixing point of the anchor wire 120 relative to the lesion X functions as an anchor point A3 for lifting the lesion X by the traction force of the elastic ring member 110. In addition, the anchor wire 120 is made of a material that does not expand and contract in the traction direction, so the traction force of the elastic ring member 110 can be reliably transmitted.

[0135] By defining three anchor points A1 , A2 , and A3 at the lesion X in this manner, the lesion X can be pulled toward the opposing site Y by the pulling force of the elastic ring member 110 , thereby lifting the lesion X.

[0136] After the lesion X is pulled and lifted toward the opposite part Y, an endoscope electric scalpel or the like (not shown) is inserted through the endoscope, and the outer periphery of the lesion X is incised using the electric scalpel or the like. Usually, the lesion X is generated from the mucosal layer, so the lesion X is lifted using the endoscope traction jig 1A, and the endoscope electric scalpel or the like is inserted into the outer periphery of the lesion X, and the electric scalpel or the like is used to incise the submucosal layer including the mucosal layer where the lesion X is generated, thereby enabling the lesion X to be peeled off from the hollow organ.

[0137] Fig.14 The lesion X is peeled off to generate a peeling portion Z. The lesion X is lifted from the peeling portion Z generated by the incision by the elastic force (tension) of the elastic ring member 110, so the lesion X does not block the field of vision around the peeling portion Z or hinder the operation, and the entire circumference of the lesion X can be incised easily and reliably.

[0138] Then, after the lesion X is peeled off, the elastic ring member 110 is cut off using an endoscope electric scalpel or the like. When the elastic ring member 110 is cut off, the lesion X in the state where the first clamp 10A and the second clamp 10B are installed, and the portion other than the elastic ring member 110 of the endoscope traction clamp 1A becomes free from the hollow organ, so that the lesion X can be grasped by the connecting hook 61 of the clamp device 60 or the endoscope grasping forceps, etc., and pulled out of the body through the endoscope or together with the endoscope, thereby removing the lesion X from the body. After the lesion X is removed, as shown in FIG. Fig.15 As shown in FIG. 1 , the peeling portion Z remains at the location where the lesion X exists, so that the treatment is completed by appropriately performing hemostasis treatment or the like. In addition, similarly to the lesion X, the cut elastic ring member 110 can be grasped by the connecting hook 61 of the clamp device 60 or the grasping forceps for the endoscope and removed from the body. In addition, the third clamp 10C fixed to the opposite location Y remains in the hollow organ (at Fig.15 (not shown in the figure), but like a general endoscopic clip, it will naturally fall off and be excreted over time due to the metabolism of the hollow organs.

[0139] In addition, in order to remove the lesion X that has been peeled off from the body, the arm plates 30C and 40C of the third clamp 10C can be opened by using the connecting hook 61 of the clamp device 60 or the grasping forceps for the endoscope, so that the third clamp 10C can be removed from the relative part Y, and the lesion X can be freed from the hollow organ.

[0140] In the above-mentioned method for peeling off the lesion X, the anchor point A3 is determined by fixing a part of the anchor wire 120 to the lesion X using the second clamp 10B, but the anchor wire 120 may be fixed to the lesion X without using the second clamp 10B, and only two anchor points, namely the anchor point A1 determined using the clamp body 10 and the anchor point A2 determined using the first clamp 10A, may be provided to the lesion X to pull the lesion X. Alternatively, four or more anchor points may be provided to the lesion X, such as by fixing a part of the anchor wire 120 (a part different from the anchor point A3) to the lesion X using another clamp, to pull the lesion X. The number of anchor points provided to the anchor wire 120 is not particularly limited, and a plurality of anchor points may be appropriately determined by fixing any part of the anchor wire 120 to the lesion X using a plurality of clamps as needed.

[0141] (Function of the endoscope traction clamp 1A)

[0142] Hereinafter, the operation of the traction clip for endoscope 1A which is one embodiment of the traction clip for endoscope of the present invention will be described.

[0143] The endoscope traction clamp 1A of the first embodiment includes a clamp body 10 and a ring member 100. The clamp body 10 includes a pair of arm plates 30 and 40 that are opened in a substantially V-shape, and a ring-shaped tightening ring 50 that is slidably fitted on the connecting plate 20 on the base end side of the arm plates 30 and 40. The ring member 100 is attached to the clamp body 10, and is configured to form a ring by connecting an elastic portion P1 having elasticity that expands and contracts in the ring extension direction and an inelastic portion P2 that has flexibility and does not expand and contract in the ring extension direction.

[0144] In more detail, in the traction clamp for endoscope 1A of the first embodiment, the elastic portion P1 is composed of the elastic ring member 110 formed into a ring shape, and the inelastic portion P2 is composed of the anchor wire 120 which is an inelastic wire having flexibility and the first inelastic ring member 130 and the second inelastic ring member 140 which are respectively formed into a ring shape at both ends of the anchor wire 120. In addition, the first inelastic ring member 130 and the second inelastic ring member 140 are respectively connected to both ends of the elastic ring member 110 constituting the elastic portion P1, and in the ring member 100, the elastic ring member 110, the anchor wire 120, the first inelastic ring member 130, and the second inelastic ring member 140 are connected to form a ring as a whole.

[0145] As described above, the endoscope traction clip 1A has a simple structure in which the ring member 100 partially having the elastic portion P1 and partially having the non-elastic portion P2 is attached to the clip body 10 capable of grasping biological tissue.

[0146] Thus, by installing the clamp body 10 at a specified position near the lesion X, the anchor point A1 fixed to the lesion X can be determined, and further by using another clamp (the first clamp 10A and the second clamp 10B) to fix the non-elastic part P2 at other positions near the lesion X, the anchor points A2 and A3 can be determined, and the anchor points A1, A2, and A3 used for traction can be determined at multiple positions (more than two points) near the lesion X.

[0147] In addition, by using the inelastic portion P2 to determine the anchor points A1, A2, and A3 of the lesion X, the traction force acting when the lesion X is lifted is reliably transmitted to the anchor points A1, A2, and A3 as the tension of the inelastic portion P2, thereby enabling the lesion X to be stably lifted.

[0148] Furthermore, since the two different points of the inelastic portion P2 are located at positions separated from each other due to the inelastic inelastic portion P2, the two different points separated from each other in the inelastic portion P2 can be easily and reliably determined as anchor points A1, A2, and A3 fixed near the lesion X. For example, since the anchor wire 120 is inserted between the first inelastic ring member 130 and the second inelastic ring member 140, the first inelastic ring member 130 and the second inelastic ring member 140 are arranged at positions separated from each other, the anchor point A1 for fixing the first inelastic ring member 130 to the lesion X and the anchor point A2 for fixing the second inelastic ring member 140 to the lesion X can be easily and reliably determined at the respective separated positions, and the lesion X can be lifted as a whole.

[0149] In the endoscope traction jig 1A of the first embodiment, a part of the inelastic portion P2 constituting the ring member 100 is constituted by an annular inelastic ring member. More specifically, the inelastic portion P2 of the endoscope traction jig 1A is constituted by a first annular inelastic ring member 130 and a second annular inelastic ring member 140 .

[0150] According to this structure, by fixing the first inelastic ring member 130 and the second inelastic ring member 140 of the inelastic portion P2 near the lesion X, the positions where the first inelastic ring member 130 and the second inelastic ring member 140 are provided can be easily and reliably determined as anchor points A1 and A2 fixed near the lesion X. Since the first inelastic ring member 130 and the second inelastic ring member 140 are formed in a ring shape, by hooking another clamp to the rings of the first inelastic ring member 130 and the second inelastic ring member 140 and fixing it to the lesion X, the first inelastic ring member 130 and the second inelastic ring member 140 can be easily and reliably fixed near the lesion X.

[0151] In the endoscope traction clip 1A of the first embodiment, since the first inelastic ring member 130 of the inelastic portion P2 is mounted on the arm plate portion 30 of the clip body 10, when the clip body 10 is mounted on the lesion X, the position where the clip body 10 is mounted can be easily determined as the anchor point A1.

[0152] Furthermore, in the traction jig 1A for an endoscope of the first embodiment, any one or more points of the anchor wire 120 inserted between the first inelastic ring member 130 and the second inelastic ring member 140 can be appropriately selected and fixed near the lesion X. Thus, in addition to the anchor point A1 of the first inelastic ring member 130 and the anchor point A2 of the second inelastic ring 140, any one (or more) points of the anchor wire 120 can be determined as the anchor point A3, and the lesion X can be stably lifted by traction of a total of three or more anchor points A1, A2, and A3.

[0153] In the traction clamp 1A for endoscope of the first embodiment, by using another clamp (third clamp 10C) to fix the elastic part P1 to the opposite part Y of the lesion X, the lesion X can be lifted by the traction force (elastic force). The elastic part P1 has elasticity to expand and contract, and when the periphery of the lesion X is cut and peeled from the inner wall of the hollow organ, the lesion X can be lifted in a direction away from the inner wall of the hollow organ (the opposite direction of the lesion X), so that the peeling part Z generated after the peeling of the lesion X can be easily seen, and the lifting of the lesion X is maintained, so that the whole periphery of the lesion X can be easily and reliably cut without hindering the operation.

[0154] In the endoscope traction clamp 1A of the first embodiment, the elastic portion P1 is composed of an elastic ring member 110 formed in a ring shape. Therefore, after a plurality of anchor points A1, A2, and A3 are determined near the lesion X, when another clamp (third clamp 10C) is used to fix the elastic portion P1 to the corresponding portion Y of the lesion X, the elastic ring member 110 can be easily fixed to the corresponding portion Y by hooking and clamping the loop of the elastic ring member 110 with the arm plate portions 30C and 40C of the third clamp 10C.

[0155] Furthermore, the endoscope traction clamp 1A of the first embodiment can be easily manufactured by manufacturing the ring member 100 connecting the elastic portion P1 formed of an elastomer molded part and the inelastic portion P2 formed of a wire material using natural fibers or chemical fibers and attaching the ring member 100 to the clamp body 10 .

[0156] (Second embodiment)

[0157] A traction clip 1B for an endoscope according to a second embodiment of the present invention will be described. Hereinafter, description of the same configurations as those of the first embodiment will be simplified or omitted, and the same reference numerals will be used.

[0158] (Structure of endoscope traction clamp 1B)

[0159] Fig.161 is a perspective view showing the entire structure of an endoscope traction clip 1B according to a second embodiment of the present invention, and is a view showing a state in which the arm plates 30 and 40 of the clip body 10 are opened. Fig.17 yes Fig.16 The front view of the endoscope traction clamp 1B is shown.

[0160] The endoscope traction clip 1B according to the second embodiment is roughly configured to include a clip body 10 and a ring member 100B.

[0161] The clamp body 10 includes a connecting plate portion (connecting portion) 20, a pair of arm plate portions (arm portions) 30, 40, and a clamp ring 50. The clamp body 10 may be the same as the clamp body 10 of the first embodiment described above.

[0162] The ring member 100B is a member that is mounted on the clamp body 10 and is formed into a ring shape. Similar to the ring member 100 of the first embodiment described above, the ring member 100B is composed of an elastic portion P3 having elasticity that expands and contracts in the ring extension direction and a non-elastic portion P4 that has flexibility and is non-elastic in the ring extension direction. That is, the ring member 100B is a member that is formed into a ring shape, and adopts a structure that partially has the elastic portion P3 and partially has the non-elastic portion P4 in the ring extension direction.

[0163] In the second embodiment, the elastic portion P3 of the ring member 100B is composed of an elastic ring member 110B formed in a ring shape. The elastic ring member 110B can use the same elastic ring member as the elastic ring member 110 of the first embodiment described above. Similar to the elastic ring member 110 of the first embodiment described above, an intermaxillary rubber band is used for the elastic ring member 110B of the second embodiment.

[0164] In the second embodiment, the inelastic portion P4 of the ring member 100B is composed of an anchor wire 120B, a first inelastic ring member 130B, and a second inelastic ring member 140B. The anchor wire 120B is composed of a wire having flexibility and not stretching in the ring extension direction. The first inelastic ring member 130B and the second inelastic ring member 140B are respectively connected to both ends of the anchor wire 120B and are also composed of a wire having flexibility and not stretching in the ring extension direction. The first inelastic ring member 130B and the second inelastic ring member 140B are annular members that are not connected to each other but have independent rings, and are respectively connected to both ends of the anchor wire 120B and are respectively connected to the elastic ring member 110B constituting the elastic portion P3 of the ring member 100B.

[0165] The anchor wire 120B, the first inelastic ring member 130B, and the second inelastic ring member 140B are not particularly limited as long as they are flexible and bendable on the one hand and inelastic in that they do not stretch relative to their extending direction on the other hand. Surgical sutures made of nylon are used for the anchor wire 120B, the first inelastic ring member 130, and the second inelastic ring member 140B of the second embodiment.

[0166] Similar to the first embodiment described above, the first inelastic ring member 130B and the second inelastic ring member 140B are respectively connected to both ends of the elastic ring member 110B constituting the elastic portion P3, and the first inelastic ring member 130B, the elastic ring member 110B, and the second inelastic ring member 140B are connected in a chain-like structure. That is, the ring member 100B of the second embodiment is similar to the ring member 100 of the first embodiment, and the elastic ring member 110B, the anchor wire 120B, the first inelastic ring member 130B, and the second inelastic ring member 140B are connected to form a ring as a whole.

[0167] In this way, the elastic ring member 110B constituting the elastic portion P3, the first inelastic ring member 130B constituting the inelastic portion P4, the anchor wire 120B, and the second inelastic ring member 140B are connected in an annular shape to form a ring, thereby constituting the ring member 100B.

[0168] The ring member 100B is mounted on the arm plate portions 30 and 40 of the clamp body 10. In the first embodiment described above, a structure is adopted in which either the first inelastic ring member 130 or the second inelastic ring member 140 is mounted on either the arm plate portions 30 and 40 of the clamp body 10. However, in the second embodiment, Fig.16 As shown, the anchor wire 120B is attached to the arm plate portion 30 of the clamp body 10 by inserting the anchor wire 120B into the through portion 31 formed in the gripping portion 30g of the arm plate portion 30 to associate them. In addition, the anchor wire 120B and the arm plate portion 30 may be fixed to each other, or may be free to move freely relative to each other. Here, the anchor wire 120B and the arm plate portion 30 are in a state where the anchor wire 120B is inserted into the through portion 31 of the arm plate portion 30 but is free relative to each other.

[0169] like Fig.16 and Fig.17 As shown in FIG. 1 , a connecting member 150B may be further provided in the traction jig 1B for an endoscope according to the second embodiment.

[0170] The connecting member 150B is a member that connects the arm plate portion 30 of the clamp body 10 to the elastic ring member 110B, and is composed of, for example, a wire material that is flexible and can be flexibly bent on one hand and has a non-elasticity relative to its extension direction on the other hand (a non-elastic wire material that does not have rubber elasticity). As a material for the connecting member 150B, wire materials such as silk, nylon, polyester, polypropylene, stainless steel, titanium, etc. can be used. As an example, a surgical suture made of natural fiber or chemical fiber can be used. A surgical suture made of silk is used for the connecting member 150B of the second embodiment.

[0171] One end of the connecting member 150B is attached to the arm plate portion 30 to which the anchor wire 120B is attached, and the other end of the connecting member 150B is attached to the elastic ring member 110B. The through portion 31 of the arm plate portion 30 can be used to connect the connecting member 150B and the arm plate portion 30.

[0172] The method of connecting the connecting member 150B, the arm plate portion 30 and the elastic ring member 110B is not particularly limited. For example, the connecting member 150B, the arm plate portion 30 and the elastic ring member 110B may be fixed to each other, or rings may be formed at both ends of the connecting member 150B, and the rings at both ends of the connecting member 150B are connected to the through-portion 31 of the arm plate portion 30 and the elastic ring member 110B in a free state in a manner that they can move freely relative to each other. Here, by fixing the ends of the connecting member 150B to the through-portion 31 of the arm plate portion 30 and the elastic ring member 110B, respectively, the connecting member 150B and the arm plate portion 30 are connected and fixed, and the connecting member 150B and the elastic ring member 110B are connected and fixed.

[0173] The connecting member 150B has a function as a traction force transmission member that transmits the traction force of the elastic ring member 110B generated when the lesion is lifted to the part where the clamp body 10 is fixed to the lesion. The length of the connecting member 150B can be appropriately set according to the type and size of the hollow organ in the body where the lesion is located, the anchor wire 120B, etc., and can be set to a length shorter than half the length of the anchor wire 120B, for example.

[0174] like Fig.16 and Fig.17 As shown, in the endoscope traction clip 1B of the second embodiment, a traction ring member (inelastic ring member) 160B may be further attached to a part of the elastic ring member 110B constituting the elastic portion P3 .

[0175] The traction ring member 160B is composed of a non-elastic wire material (non-elastic wire material without rubber elasticity) that is flexible and can be bent flexibly on the one hand and does not stretch relative to its extension direction on the other hand. As the material of the traction ring member 160B, wire materials composed of silk, nylon, polyester, polypropylene, stainless steel, titanium, etc. can be used. As an example, surgical sutures made of natural fibers or chemical fibers can be used. Here, surgical sutures made of nylon are used for the traction ring member 160B.

[0176] The traction ring member 160B is a member formed in an annular shape and is mounted on a part of the elastic ring member 110B constituting the elastic portion P3. The method of connecting the traction ring member 160B and the elastic ring member 110B is not particularly limited. For example, the traction ring member 160B and the elastic ring member 110B may be fixed to each other, or may be connected in a state of being free to move freely to each other. Here, the ring of the elastic ring member 110B and the ring of the traction ring member 160B are fixed by using a fixing wire 161B, so that the traction ring member 160B and the elastic ring member 110B are connected and fixed.

[0177] The traction ring member 160B is a member used when the endoscope traction clamp 1B is mounted on the relative part of the lesion. When the endoscope traction clamp 1A of the first embodiment is mounted on the relative part of the lesion, the ring of the elastic ring member 110B is hooked by another clamp and the relative part is grasped. In contrast, in the endoscope traction clamp 1B of the second embodiment, the ring of the traction ring member 160B is hooked by another clamp and the relative part is grasped, so that the endoscope traction clamp 1B can be mounted on the relative part of the lesion. The length of the ring of the traction ring member 160B can be appropriately set according to the type and size of the hollow organ in the body where the lesion exists, and can be set to the same size as the first inelastic ring member 130B or the second inelastic ring member 140B.

[0178] The endoscope traction clip 1B according to the second embodiment can be transported into the body using the clip device 60 described above. Fig.18 1B is a diagram showing a state in which the endoscope traction clip 1B according to the second embodiment is protruded from the distal end of the clip device 60. Fig.19 This is a diagram showing a state in which the endoscope traction clip 1B according to the second embodiment is accommodated in the distal end portion of a clip device 60 .

[0179] The traction clip 1B for an endoscope according to the second embodiment can be transported into the body in a state accommodated in the distal end portion of the clip device 60 , similarly to the traction clip 1A for an endoscope according to the first embodiment described above.

[0180] By engaging the connecting hook 61 of the clamp device 60 with the connecting hole 25 formed in the connecting plate portion 20 of the clamp body 10, the connecting hook 61 is pulled into the interior of the inner sheath 62, thereby closing the connecting hook 61. Fig.18 As shown, the clip body 10 of the endoscope traction clip 1B is attached to the distal end portion of the inner sheath 62 .

[0181] In this state, the distal end portion of the inner sheath 62 to which the endoscope traction jig 1B (the jig body 10 and the ring member 100B) is connected is pulled into the outer sheath 64. Fig.19 As shown, the endoscope traction clamp 1B (clamp body 10 and ring member 100B) is entirely housed inside the distal end portion of the outer sheath 64. Thus, the elastic ring member 110B, anchor wire 120B, first inelastic ring member 130B, second inelastic ring member 140B, connecting member 150B, and traction ring member 160B constituting the ring member 100B are housed in the outer sheath 64 together with the clamp body 10.

[0182] Furthermore, when the outer sheath 64 is slid toward the base end from the stored state, the endoscope traction jig 1B is protruded from the distal end of the outer sheath 64. Fig.18 As shown, the elastic ring member 110B, the anchor wire 120B, the first inelastic ring member 130B, the second inelastic ring member 140B, the connecting member 150B, and the traction ring member 160B constituting the ring member 100B are released to the outside of the outer sheath 64, and the arm plate portions 30 and 40 are in a state of being opened by their own elasticity.

[0183] (Method of peeling off a lesion using the traction clip 1B for an endoscope)

[0184] Below, while referring to Figure 20 to Figure 24 , a method for peeling off a lesion using the traction clip 1B for an endoscope according to the second embodiment will be described. Figure 20 to Figure 24 The diagram schematically shows each step of the lesion peeling method using the traction clip 1B for an endoscope according to the second embodiment.

[0185] The traction clamp 1B for an endoscope of the second embodiment is used when peeling and removing a lesion formed on the inner wall of a hollow organ in the body by ESD. Fig. 9 As shown, the case of peeling and resecting the mucosa (biological tissue) including the lesion X generated in the large intestine wall W will be described. The endoscope traction clip 1B of this embodiment can be applied not only to the large intestine but also to hollow organs such as the esophagus, stomach, and duodenum.

[0186] The tip of the endoscope (not shown) is positioned near the lesion X through the mouth or nose. Then, the tip of the sheath tube of the clamp device 60 equipped with the endoscope traction clamp 1B is inserted into the body using the tip of the endoscope, and positioned near the lesion X to be incised (stripped). Next, the outer sheath 64 is slid toward the base end side, so that the endoscope traction clamp 1B protrudes from the distal end of the outer sheath 64, the arm plates 30 and 40 are in a state of being opened by their own elasticity, and the elastic ring member 110B, the anchor wire 120B, the first inelastic ring member 130B, the second inelastic ring member 140B, the connecting member 150B, and the traction ring member 160B constituting the ring member 100B are deployed near the lesion X.

[0187] With the arm plates 30 and 40 open, the clamp body 10 of the endoscope traction clamp 1B is positioned near the lesion X. The clamp body 10 is preferably disposed at a position where it can grip a portion near the periphery of the lesion X (for example, the front portion of the lesion X).

[0188] Next, while pressing the clamp body 10 against the desired position of the lesion X (for example, the front part of the lesion X), the inner sheath 62 is slid toward the distal end relative to the driving wire 63, so that the tightening ring 50 slides toward the distal end of the arm plate parts 30 and 40. As a result, the arm plate parts 30 and 40 gradually close (approach each other) and can grasp the lesion X (the front part of the lesion X). By further sliding the inner sheath 62 toward the distal end relative to the driving wire 63, the tightening ring 50 moves toward the grasping parts 30g and 40g of the arm plate parts 30 and 40, and the lesion X is grasped by the clamp body 10 of the endoscope traction clamp 1B.

[0189] In this state, the inner sheath 62 is slid toward the proximal end relative to the driving wire 63, so that the connecting hook 61 is pushed out from the distal end of the inner sheath 62 and opened, and the grip (engagement) of the clamp body 10 by the connecting hook 61 is released, and the endoscope traction clamp 1B is released, and the clamp body 10 of the endoscope traction clamp 1B is clamped on the lesion X ( Fig. 20 status shown).

[0190] As described above, the anchor wire 120B is inserted into the through portion 31 of one arm plate portion 30 of the clamp body 10. Therefore, a portion of the anchor wire 120B is fixed to the lesion X grasped by the clamp body 10. The portion where the anchor wire 120B is fixed to the lesion X functions as an anchor point A4 when the lesion X is pulled as described later.

[0191] Next, the clamp device 60 is temporarily pulled out of the endoscope, and then another clamp (first clamp) 10A prepared separately is attached to the distal end of the clamp device 60 (or a clamp device prepared separately having the same structure as the clamp device 60), and the distal end of the sheath tube portion of the clamp device 60 attached with the first clamp 10A is inserted into the body so as to be located near the lesion X. In addition, as the first clamp 10A, a clamp having the same structure as that of the endoscope can be used. Fig.17 and Fig.18 The illustrated endoscope traction clamp 1B is an endoscope clamp having the same structure as the clamp body 10 except that the ring member 100B is removed.

[0192] Next, similarly to the clamp body 10 of the endoscope traction clamp 1B, the first clamp 10A is protruded from the distal end of the outer sheath 64, and the pair of arm plates 30A and 40A of the first clamp 10A are opened by their own elasticity. Then, one of the pair of arm plates 30A and 40A of the first clamp 10A is hooked on the loop of the first inelastic ring member 130B, and one of the arm plates 30A and 40A is inserted into the loop of the first inelastic ring member 130B, and the first clamp 10A is arranged at a position where it can grasp a different part (for example, the right end of the lesion X) from the already arranged clamp body 10.

[0193] Next, similar to the gripping by the clamp body 10 of the endoscope traction clamp 1B, the first clamp 10A is pressed against the desired position of the lesion X (for example, the right end of the lesion X), and the tightening ring 50A is slid toward the tip side of the arm plate parts 30A and 40A, and the lesion X (the right end of the lesion X) is gripped by the first clamp 10A. Then, by releasing the first clamp 10A, the gripping of the lesion X by the first clamp 10A is completed ( Fig.21 status shown).

[0194] As described above, one of the arm plates 30A and 40A of the first clamp 10A is inserted into the loop of the first inelastic ring member 130B, and the arm plates 30A and 40A sandwich and grasp the wire rod constituting the first inelastic ring member 130B together with the lesion X. As a result, a part of the wire rod constituting the first inelastic ring member 130B is fixed to the lesion X grasped by the first clamp 10A. The part where the wire rod constituting the first inelastic ring member 130B is fixed to the lesion X functions as an anchor point A5 when the lesion X is pulled as described later.

[0195] Next, the clamp device 60 is temporarily pulled out of the endoscope, and then another clamp (second clamp) 10B prepared separately is attached to the distal end of the clamp device 60 (or a clamp device prepared separately having the same structure as the clamp device 60), and the distal end of the sheath portion of the clamp device 60 equipped with the second clamp 10B is inserted into the body so as to be located near the lesion X. In addition, as the second clamp 10B, a clamp having the same structure as the first clamp 10A can be used. Fig.17 and Fig.18 The illustrated endoscope traction clamp 1B is an endoscope clamp having the same structure as the clamp body 10 except that the ring member 100B is removed.

[0196] Next, similarly to the clamp body 10 and the first clamp 10A of the endoscope traction clamp 1B, the second clamp 10B is protruded from the distal end of the outer sheath 64, and the pair of arm plates 30B and 40B of the second clamp 10B are opened by their own elasticity. Then, one of the pair of arm plates 30B and 40B of the second clamp 10B is hooked on the ring of the second inelastic ring member 140B, and one of the arm plates 30B and 40B is inserted into the ring of the second inelastic ring member 140B, and the second clamp 10B is arranged at a position where it can grasp a portion (for example, the left end portion of the lesion X) different from the already arranged clamp body 10 and the first clamp 10A.

[0197] Next, similar to the gripping performed by the clamp body 10 and the first clamp 10A of the endoscope traction clamp 1B, the second clamp 10B is pressed against the desired portion of the lesion X (for example, the left end portion of the lesion X) while the tightening ring 50B is slid toward the tip side of the arm plate portions 30B and 40B, and the lesion X (the left end portion of the lesion X) is gripped by the second clamp 10B. Then, by releasing the second clamp 10B, the gripping of the lesion X by the second clamp 10B is completed ( Fig. 22 status shown).

[0198] As described above, one of the arm plates 30B and 40B of the second clamp 10B is inserted into the loop of the second inelastic ring member 140B, and the arm plates 30B and 40B sandwich and grasp the wire rod constituting the second inelastic ring member 140B together with the lesion X. As a result, a part of the wire rod constituting the second inelastic ring member 140B is fixed to the lesion X grasped by the second clamp 10B. The part where the wire rod constituting the second inelastic ring member 140B is fixed to the lesion X functions as an anchor point A6 when the lesion X is pulled as described later.

[0199] Next, the clamp device 60 is temporarily pulled out from the endoscope, and then another clamp (third clamp) 10C prepared separately is attached to the top end of the clamp device 60 (or a clamp device prepared separately having the same structure as the clamp device 60), and the top end of the sheath tube portion of the clamp device 60 equipped with the third clamp 10C is inserted into the body and transported to the vicinity of an appropriate portion (opposite portion) Y opposite to the lesion X. The opposite portion Y is, for example, the inner wall of a hollow organ opposite to the lesion X. In addition, as the third clamp 10C, a clamp having the same structure as the first clamp 10A and the second clamp 10B can be used. Fig.17 and Fig.18 The endoscope traction clamp 1B shown has the same structure as the clamp main body 10 except that the ring member 100B is removed.

[0200] Next, similarly to the clamp body 10, the first clamp 10A, and the second clamp 10B of the endoscope traction clamp 1B, the third clamp 10C is protruded from the distal end of the outer sheath 64, and the pair of arm plates 30C and 40C of the third clamp 10C are opened by their own elasticity. Then, one of the pair of arm plates 30C and 40C of the third clamp 10C is hooked on the ring of the traction ring member 160B, and one of the arm plates 30C and 40C is inserted into the ring of the traction ring member 160B, and the third clamp 10C is arranged at a position where it can grip the opposing part Y.

[0201] Next, the lesion X is lifted while the elastic ring member 110B is stretched by the traction ring member 160B, and the third clamp 10C is pressed against the portion Y opposite to the lesion X, while the tightening ring 50C is slid toward the top end of the arm plate portions 30C and 40C, so that the portion Y opposite to the lesion X is grasped by the third clamp 10C. Then, by releasing the third clamp 10C, the portion Y opposite to the lesion X is grasped by the third clamp 10C ( Fig.23 status shown).

[0202] As described above, one of the arm plates 30C and 40C of the third clamp 10C is inserted into the traction ring member 160B, and the arm plates 30C and 40C sandwich and grasp a part of the wire material constituting the traction ring member 160B together with the portion Y facing the lesion X. As a result, a part of the wire material constituting the traction ring member 160B is fixed to the portion Y facing the lesion X grasped by the third clamp 10C.

[0203] exist Fig.23 In the illustrated state, a force (traction force) that pulls the lesion X in the direction of the opposing site Y by its elastic force (tension) acts on the elastic ring member 110B.

[0204] The anchor wire 120B is fixed to the lesion X (the front part of the lesion X) by the clamp body 10. Both ends of the anchor wire 120B are connected to the first inelastic ring member 130B and the second inelastic ring member 140B, and the traction force of the elastic ring member 110B is transmitted through at least one or both of the first inelastic ring member 130B and the second inelastic ring member 140B. Thus, the fixing point of the anchor wire 120B relative to the lesion X functions as an anchor point A4 for lifting the lesion X by the traction force of the elastic ring member 110B. In addition, the anchor wire 120B is made of a material that does not stretch in the traction direction, so it can reliably transmit the traction force of the elastic ring member 110B.

[0205] Furthermore, the clamp body 10 and the elastic ring member 110B are connected by the connecting member 150B, and the traction force of the elastic ring member 110B is transmitted to the clamp body 10 fixed at the anchor point A4 via the connecting member 150B. Thus, for example, even if sufficient traction force is not transmitted through at least one or both of the first inelastic ring member 130B and the second inelastic ring member 140B, the traction force of the elastic ring member 110B can be transmitted to the anchor point A4 via the connecting member 150B. In addition, the connecting member 150B is made of a material that does not expand and contract in the traction direction, so the traction force of the elastic ring member 110B can be reliably transmitted.

[0206] The first inelastic ring member 130B connected to the elastic ring member 110B is fixed to the lesion X (the right end of the lesion X) by the first clamp 10A. The fixing point of the first inelastic ring member 130B with respect to the lesion X functions as an anchor point A5 for lifting the lesion X by the traction force of the elastic ring member 110. In addition, the first inelastic ring member 130B is made of a material that does not expand or contract in the traction direction, so the traction force of the elastic ring member 110B can be reliably transmitted.

[0207] The second inelastic ring member 140B connected to the elastic ring member 110B is fixed to the lesion X (the left end of the lesion X) by the second clamp 10B. The fixing point of the second inelastic ring member 140B with respect to the lesion X functions as an anchor point A6 for lifting the lesion X by the traction force of the elastic ring member 110B. In addition, the second inelastic ring member 140B is made of a material that does not expand or contract in the traction direction, so the traction force of the elastic ring member 110B can be reliably transmitted.

[0208] By defining the three anchor points A4, A5, and A6 at the lesion X in this manner, the lesion X can be pulled toward the opposing site Y by the pulling force of the elastic ring member 110B, thereby lifting the lesion X.

[0209] After the lesion X is pulled and lifted toward the opposite part Y, an endoscope electric scalpel or the like (not shown) is inserted through the endoscope, and the outer periphery of the lesion X is incised using the electric scalpel or the like. Usually, the lesion X is generated from the mucosal layer, so the lesion X is lifted by using the endoscope traction jig 1B, the endoscope electric scalpel or the like is inserted into the outer periphery of the lesion X, and the submucosal layer including the mucosal layer where the lesion X is generated is incised using the electric scalpel or the like, thereby enabling the lesion X to be peeled off from the hollow organ.

[0210] Fig.24 The lesion X is peeled off to generate a peeling portion Z. The lesion X is lifted from the peeling portion Z generated by the incision by the elastic force (tension) of the elastic ring member 110B, so the lesion X does not block the field of vision around the peeling portion Z or hinder the operation, and the entire circumference of the lesion X can be incised easily and reliably.

[0211] Then, after the lesion X is peeled off, the elastic ring member 110B is cut off using an endoscope electric scalpel or the like. When the elastic ring member 110B is cut off, the lesion X other than the elastic ring member 110B and the traction ring member 160B of the endoscope traction clamp 1B and the state where the first clamp 10A and the second clamp 10B are installed become free from the hollow organ. Therefore, by grasping the lesion X using the connecting hook 61 of the clamp device 60 or the endoscope grasping forceps or the like, and pulling it out of the body through the endoscope or together with the endoscope, the lesion X can be removed from the body. After the lesion X is removed, as described above, Fig.15 As shown, the peeling portion Z remains at the position where the lesion X exists, so the treatment is completed by appropriately performing hemostasis treatment. In addition, similar to the lesion X, the cut elastic ring member 110B and the traction ring member 160B can be grasped by the connecting hook 61 of the clamp device 60 or the endoscope grasping forceps and removed from the body. In addition, the third clamp 10C fixed to the relative position Y remains in the hollow organ, but like a general endoscopic clamp, it naturally falls off and is discharged over time due to the metabolism of the hollow organ.

[0212] In addition, another clamp may be used to fix a portion of the anchor wire 120B (a portion different from the anchor point A4) to the lesion X, and four or more anchor points may be provided at the lesion X to pull the lesion X. The number of anchor points provided at the anchor wire 120B is not particularly limited, and a plurality of anchor points may be appropriately determined by fixing any portion of the anchor wire 120B to the lesion X using a plurality of clamps as needed.

[0213] (Function of the endoscope traction clamp 1B)

[0214] Hereinafter, the operation of the traction clip for endoscope 1B which is one embodiment of the traction clip for endoscope of the present invention will be described.

[0215] The traction clamp 1B for endoscope of the second embodiment has a clamp body 10 and a ring member 100B. The clamp body 10 has a pair of arm plates 30 and 40 opened in a substantially V-shape and a ring-shaped tightening ring 50 slidably fitted on the connecting plate 20 on the base end side of the arm plates 30 and 40. The ring member 100B is mounted on the clamp body 10 and is formed in a ring shape. The ring member 100B is composed of an elastic part P3 having elasticity that expands and contracts in the ring extension direction and an inelastic part P4 having flexibility and inelasticity that does not expand and contract in the ring extension direction.

[0216] In more detail, in the traction clamp 1B for endoscope of the second embodiment, the elastic part P3 is composed of an elastic ring member 110B formed into a ring shape, and the inelastic part P4 is composed of an anchor wire 120B which is an inelastic wire having flexibility, and a first inelastic ring member 130B and a second inelastic ring member 140B which are respectively formed into a ring shape at both ends of the anchor wire 120B. In addition, the first inelastic ring member 130B and the second inelastic ring member 140B are respectively connected to both ends of the elastic ring member 110B constituting the elastic part P3, and in the ring member 100B, the elastic ring member 110B, the anchor wire 120B, the first inelastic ring member 130B, and the second inelastic ring member 140B are connected to form a ring as a whole.

[0217] As described above, the endoscope traction clip 1B has a simple structure in which the ring member 100B having the elastic portion P3 partially and the non-elastic portion P4 partially is attached to the clip body 10 capable of grasping biological tissue.

[0218] Thus, by installing the clamp body 10 at a specified position near the lesion X, the anchor point A4 fixed to the lesion X can be determined, and further by using another clamp (the first clamp 10A and the second clamp 10B) to fix the non-elastic part P4 at other positions near the lesion X, the anchor points A5 and A6 can be determined, and the anchor points A4, A5, and A6 for traction can be determined at multiple positions (more than two points) near the lesion X.

[0219] In addition, by using the inelastic part P4 to determine the anchor points A4, A5, and A6 of the lesion part X, the traction force acting when the lesion part X is lifted is reliably transmitted to the anchor points A4, A5, and A6 as the tension of the inelastic part P4 that does not stretch, thereby enabling the lesion part X to be stably lifted.

[0220] Furthermore, since the two different points of the inelastic portion P4 are located at positions separated from each other due to the inelastic inelastic portion P4, the two different points separated from each other in the inelastic portion P4 can be easily and reliably determined as anchor points A4, A5, and A6 fixed near the lesion X. For example, since the anchor wire 120B is inserted between the first inelastic ring member 130B and the second inelastic ring member 140B, the first inelastic ring member 130B and the second inelastic ring member 140B are arranged at positions separated from each other, the anchor point A5 for fixing the first inelastic ring member 130B to the lesion X and the anchor point A6 for fixing the second inelastic ring member 140B to the lesion X can be easily and reliably determined at the respective separated positions, and the lesion X can be lifted as a whole.

[0221] In the endoscope traction jig 1B of the second embodiment, a part of the inelastic portion P4 constituting the ring member 100B is constituted by an inelastic ring member formed in an annular shape. More specifically, the inelastic portion P4 of the endoscope traction jig 1B is constituted by a first inelastic ring member 130B and a second inelastic ring member 140B formed in an annular shape.

[0222] According to this structure, by fixing the first inelastic ring member 130B and the second inelastic ring member 140B of the inelastic portion P4 near the lesion X, the positions where the first inelastic ring member 130B and the second inelastic ring member 140B are provided can be easily and reliably determined as the anchor points A5 and A6 fixed near the lesion X. Since the first inelastic ring member 130B and the second inelastic ring member 140B are formed in a ring shape, by hooking another clamp to the rings of the first inelastic ring member 130B and the second inelastic ring member 140B and fixing them to the lesion X, the first inelastic ring member 130B and the second inelastic ring member 140B can be easily and reliably fixed near the lesion X.

[0223] In the endoscope traction clip 1B of the second embodiment, since the anchor wire 120B of the inelastic portion P4 is attached to the arm plate portion 30 of the clip body 10 , the position where the clip body 10 is attached to the lesion X can be easily determined as the anchor point A4 .

[0224] In the traction clamp 1B for endoscope of the second embodiment, by using another clamp (third clamp 10C) to fix the elastic part P3 to the opposite part Y of the lesion X, the lesion X can be lifted by its traction force (elastic force). The elastic part P3 has elasticity to expand and contract, and when the periphery of the lesion X is cut and peeled off from the inner wall of the hollow organ, the lesion X can be lifted in a direction away from the inner wall of the hollow organ (the opposite direction of the lesion X), so that the peeling part Z generated after the peeling of the lesion X can be easily seen, and the lifting of the lesion X is maintained, so that the whole periphery of the lesion X can be easily and reliably cut without hindering the operation.

[0225] The endoscope traction clamp 1B of the second embodiment is provided with a connecting member 150B connecting the arm plate 30 and the elastic ring member 110B. Thus, the traction force of the elastic ring member 110B is reliably transmitted to the anchor point A4 determined by the clamp body 10 via the connecting member 150B, and the lesion X can be lifted more stably.

[0226] In the traction jig 1B for an endoscope of the second embodiment, a traction ring member 160B formed in a ring shape is attached to a part of the elastic ring member 110B constituting the elastic portion P3. Therefore, when the elastic portion P3 is fixed to the opposite portion Y of the lesion X using another jig (third jig 10C) after a plurality of anchor points A4, A5, and A6 are determined near the lesion X, it is easy to hook and clamp the ring of the traction ring member 160B with the arm plate portions 30C and 40C of the third jig 10C, and the traction ring member 160B can be easily fixed to the opposite portion Y. In addition, by constituting the traction ring member 160B using an inelastic wire material, when the traction ring member 160B is fixed to the opposite portion Y by the third jig 10C, it can be reliably fixed so as not to fall off from the opposite portion Y due to the traction force of the elastic ring member 110B.

[0227] Furthermore, the endoscope traction clamp 1B of the second embodiment can be easily manufactured by manufacturing the ring member 100B connecting the elastic portion P3 formed of an elastomer molded part and the inelastic portion P4 formed of a wire material using natural fiber or chemical fiber and attaching the ring member 100B to the clamp body 10 .

[0228] (Modification of the endoscope traction clamp of the present invention)

[0229] Below, while referring to Figure 25 to Figure 27 , while explaining first to third modified examples of the traction clamp for an endoscope of the present invention. Figure 25 to Figure 27 1 and 2 are front views showing first to third modified examples of the traction clamp for an endoscope according to the present invention. Figure 25 to Figure 272 shows an example in which the structure of the endoscope traction clip 1A according to the first embodiment of the present invention is modified.

[0230] (First Modification)

[0231] In the endoscope traction jig 1A of the first embodiment described above, an elastic molding component such as an intermaxillary rubber ring is used as the elastic ring member 110 constituting the elastic portion P1, but it may also be Fig.25 As shown in the endoscope traction clamp 1C, a ring-shaped spring member 110X formed into a ring shape by connecting the two ends of a tightly wound coil spring is used for the elastic part P1 to generate a traction force (elastic force) to lift the lesion. As the ring-shaped spring member 110X, a member connecting the two ends of a spring can be used, or a circlip can be used.

[0232] (Second Modification and Third Modification)

[0233] In the above-mentioned endoscope traction jig 1A of the first embodiment, the elastic ring member 110 constituting the elastic portion P1 is formed in a ring shape, but it may also be formed in a ring shape. Fig.26 As shown in the endoscope traction clamp 1D, an elastic member 110Y formed into an arc or a straight line is used for the elastic part P1 to generate a traction force (elastic force) to lift the lesion. Fig. 27 As in the illustrated endoscope traction jig 1E, a coil spring member 110Z extending in an arc shape or a linear shape is used for the elastic portion P1 to generate a traction force (elastic force) for lifting the lesion.

[0234] Furthermore, the first to third modified examples described above may be applied to the endoscope traction jig 1B of the second embodiment, and the elastic ring member 110B constituting the elastic portion P3 of the endoscope traction jig 1B may be replaced with the annular spring member 110X, the elastic member 110Y, or the coil spring member 110Z described above.

[0235] (Fourth Modification)

[0236] Furthermore, referring to Fig.28 and Fig.29 , while describing a fourth modified example of the endoscope traction clamp of the present invention. Fig.28 1 is a perspective view showing a fourth modified example of the endoscope traction clamp of the present invention, and is a view showing a state in which the arm plates 30 and 40 of the clamp body 10 are opened. Fig.28 2 shows an example in which the structure of the endoscope traction clip 1B according to the second embodiment of the present invention is modified.

[0237] In the above-mentioned endoscope traction clamp 1B of the above-mentioned second embodiment, the first inelastic ring member 130B and the second inelastic ring member 140B are inserted between the elastic ring member 110B and the anchor wire 120B. The first inelastic ring member 130B and the second inelastic ring member 140B are respectively connected to both ends of the anchor wire 120B, forming a structure in which the first inelastic ring member 130B, the elastic ring member 110B, and the second inelastic ring member 140B are connected in a chain shape.

[0238] In the endoscope traction jig 1B configured as above, a structure without providing the first inelastic ring member 130B and the second inelastic ring member 140B may be adopted. Fig.28 As in the endoscope traction clamp 1F shown in FIG. 1 , both ends of the anchor wire 120F corresponding to the anchor wire 120B are fixed to the elastic ring member 110B. Fig.28 As shown, for example, by providing fixing wires 121F and 122F at both ends of the anchor wire 120F and fixing the fixing wires 121F and 122F to the elastic ring member 110B, both ends of the anchor wire 120F are connected and fixed to the elastic ring member 110B.

[0239] The positions where both ends of the anchor wire 120F are fixed to the elastic ring member 110B are not particularly limited, but are preferably fixed to positions away from the connection position with the fixing wire 161B to which the traction ring member 160B is connected and fixed and the connection member 150B.

[0240] In the second embodiment of the traction clamp for endoscope 1B, as described above, by fixing a part of the wire material constituting the first inelastic ring member 130B to the lesion X using the first clamp 10A, the anchor point A5 can be determined, and by fixing a part of the wire material constituting the second inelastic ring member 140B to the lesion X using the second clamp 10B, the anchor point A6 can be determined (for example, refer to Fig. 22 ).

[0241] In contrast, Fig.28 In the endoscope traction clamp 1F shown in FIG. Fig.29 As shown, by fixing a portion of the anchor wire 120F (a portion different from the anchor point A4 based on the clamp body 10) to the lesion X using the first clamp 10A, the anchor point A7 can be determined, and by fixing a portion of the anchor wire 120F (a portion different from the anchor points A4 and A7) to the lesion X using the second clamp 10B, the anchor point A8 can be determined. Fig.29 1 is a diagram schematically showing a state in which the anchor wire 120F of the endoscope traction clamp 1F is installed on the lesion X using the first clamp 10A and the second clamp 10B, which is similar to the above-mentioned Fig. 22The status shown corresponds to

[0242] In the method of lifting and peeling the lesion X using the traction clamp 1F for an endoscope, the method is the same as the second embodiment described above, except that a part of the anchor wire 120F is attached to the lesion X using the first clamp 10A and the second clamp 10B. In addition, similarly to the second embodiment described above, the number of anchor points provided on the anchor wire 120F is not particularly limited. Fig.29 In the example shown, three anchor points A4, A7, and A8 are determined, but the anchor points may be two points or four or more points.

[0243] Compared with the endoscope traction clamp 1B of the second embodiment, the endoscope traction clamp 1F of the fourth modification does not include the first inelastic ring member 130B and the second inelastic ring member 140B, and the structure is simplified. Therefore, it is easy to store the endoscope traction clamp 1F in the top end of the clamp device 60 when transporting it into the body, and the clamping operation near the lesion X is also easy.

[0244] In addition, the endoscope traction jig 1A according to the above-mentioned first embodiment may also be configured such that the first inelastic ring member 130 and the second inelastic ring member 140 are not provided.

[0245] In addition, the present invention also includes a structure obtained by appropriately combining the components described in each embodiment. For example, the endoscope traction clip 1A of the first embodiment may be provided with the connecting member 150B and the traction ring member 160B described in the second embodiment.

[0246] The embodiments described above are described to facilitate understanding of the present invention and are not intended to limit the present invention. The components disclosed in the embodiments described above are intended to include all design changes or equivalents that fall within the technical scope of the present invention.

[0247] Description of Reference Numerals

[0248] 1A, 1B, 1C, 1D, 1E, 1F: traction clamp for endoscope;

[0249] 10: fixture body;

[0250] 10A: first clamp;

[0251] 10B: second clamp;

[0252] 10C: Third clamp;

[0253] 20: connecting plate portion (connecting portion);

[0254] 25: connection hole;

[0255] 30, 30A, 30B, 30C, 40, 40A, 40B, 40C: arm plate part (arm part);

[0256] 30g, 40g: gripping part;

[0257] 30p, 40p: base end;

[0258] 31, 41: through-portion;

[0259] 32, 42, 61a1, 61b1: claws;

[0260] 32a, 42a: notch portion;

[0261] 50, 50A, 50B, 50C: tightening ring;

[0262] 60: clamping device;

[0263] 61: connecting hook;

[0264] 61a, 61b: arms;

[0265] 61c: U-shaped part;

[0266] 62: inner sheath;

[0267] 63: driving wire;

[0268] 63a: circular ring component;

[0269] 64: outer sheath;

[0270] 65: Strengthen the coil;

[0271] 66: Slider;

[0272] 67: base;

[0273] 68: Operation department;

[0274] 100, 100B: ring member;

[0275] 110, 110B: elastic ring member;

[0276] 110X: annular spring member;

[0277] 110Y: elastic member;

[0278] 110Z: Coil spring member;

[0279] 120, 120B, 120F: anchor wire;

[0280] 121F, 122F, 161B: fixing wire;

[0281] 130, 130B: first non-elastic ring member;

[0282] 140, 140B: second non-elastic ring member;

[0283] 150B: Connecting components;

[0284] 160B: traction ring member (non-elastic ring member);

[0285] A1, A1, A2, A3, A4, A5, A6, A7, A8: anchor points;

[0286] P1, P3: elastic part;

[0287] P2, P4: non-elastic part;

[0288] X: lesion;

[0289] Y: relative position;

[0290] Z: Peeling section.

Claims

1. A traction clamp for an endoscope, characterized in that: have: A clamp body having a pair of arms opened in a substantially V-shape and a ring-shaped tightening ring slidably fitted on the connecting portion on the base end side of the arm; and A ring member is installed on the clamp body and formed in a ring shape. The ring member is composed of an elastic part and a non-elastic part connected to each other. The elastic part has elasticity that can expand and contract in the direction extending in the ring shape, and the non-elastic part has flexibility and has non-elasticity that does not expand and contract in the direction extending in the ring shape.

2. The traction clamp for endoscope according to claim 1, characterized in that: The non-elastic portion of the ring member is attached to the arm portion of the clamp body.

3. The traction clamp for endoscope according to claim 1 or 2, characterized in that: A part of the non-elastic portion of the ring member is constituted by a non-elastic ring member formed in a ring shape.

4. The traction clamp for endoscope according to claim 1 or 2, characterized in that: The inelastic portion of the ring member is composed of a flexible inelastic wire and a first inelastic ring member and a second inelastic ring member formed in a ring shape at both ends of the inelastic wire, and the first inelastic ring member and the second inelastic ring member are respectively connected to both ends of the elastic portion of the ring member.

5. The traction clamp for endoscope according to claim 1 or 2, characterized in that: The elastic portion of the ring member is composed of an elastic ring member formed in a ring shape.

6. The traction clamp for endoscope according to claim 1 or 2, characterized in that: A connecting member is provided for connecting at least one of the pair of arm portions of the clamp body and the elastic portion.

7. The traction clamp for endoscope according to claim 1 or 2, characterized in that: A non-elastic ring member formed in a ring shape is attached to a part of the elastic portion of the ring member.

8. The traction clamp for endoscope according to claim 1 or 2, characterized in that: The elastic portion is formed of an elastic molded component, and the non-elastic portion is formed of a wire material using natural fiber or chemical fiber.

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