Medical catheter

Abstract

To provide a medical catheter including a medical clip which can easily reef a cutoff part of a mucosa layer cut off in a wide range and is easy to handle.SOLUTION: A medical catheter 1 includes: a tube-type sheath 2; a medical clip 3 having a first claw part 31, a second claw part 32 and a third claw part 33; a bearing member 4 connected to the medical clip 3; and operation members 51, 52. The medical clip 3 is provided with: a first movement mechanism part 35 opening / closing the first claw part 31 and the second claw part 32; and a second movement mechanism part 36 moving the third claw part 33. The bearing member 4 has a grip part 41 which is energized to the side opening outward and is disposed inside the sheath 2, and so holds grip of the medical clip 3. The operation members 51, 52 are energized to the side where ends 51a, 52a open outward and are disposed inside the sheath 2, so that the state they are connected to the medical clip 3 is held. The sheath 2 is configured to be retractable.SELECTED DRAWING: Figure 2

Description

[Technical Field]

[0001] The present invention relates to a medical catheter. [Background technology]

[0002] In recent years, a treatment called endoscopic submucosal dissection (ESD) has become well known in the field of gastrointestinal cancer treatment. This treatment is a method of endoscopically removing the submucosal layer for relatively early stage lesions where cancer infiltration is limited to the mucosal layer of the gastrointestinal tract, such as the esophagus, stomach, and large intestine, and has the advantage of being less stressful on the patient than surgery.

[0003] It has been reported in recent years that closing the site (ulcer base) where a lesion in the gastrointestinal mucosal layer has been excised can be expected to prevent postoperative bleeding and delayed perforation by reducing inflammation. For example, the base of an ulcer formed at the site where a lesion in the gastrointestinal mucosal layer has been excised is closed by suturing with a medical clip such as an endoscopic clip. As a medical clip, for example, a medical clip with three claws is known (see, for example, Patent Document 1). The medical clip is used by being attached to a medical catheter. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] International Publication No. 2021 / 249342 Summary of the Invention [Problem to be solved by the invention]

[0005] However, existing medical clips have an opening width of approximately 6 to 11 mm, which is small, making it difficult to use them when the excised area of ​​the gastrointestinal mucosal layer (ulcer base) is large (diameter 5 cm or more). Therefore, a medical clip that can easily suture the excised area of ​​the gastrointestinal mucosal layer (ulcer base) is desired. Furthermore, since medical clips are used to suture the excised area of ​​the mucosal layer after extensive excision inside the patient's body, it is desirable that they be easy to handle.

[0006] An object of the present invention is to provide a medical catheter equipped with a medical clip that can easily suture the excised portion of a mucosal layer that has been excised over a wide area and is easy to handle. [Means for solving the problem]

[0007] The present invention provides a medical clip comprising: a tubular sheath to be inserted into a body; a medical clip provided at the distal end of the sheath and having a first claw portion, a second claw portion, and a third claw portion; a long support member that is passed through the inside of the sheath and has a distal end connected to the medical clip; and a long operating member that is passed through the inside of the sheath along the support member and has a distal end connected to the medical clip, wherein the medical clip comprises a first moving mechanism that moves the first claw portion and the second claw portion toward or away from each other simultaneously by operating the operating member, thereby opening and closing the first claw portion and the second claw portion; and a first moving mechanism that moves the third claw portion toward or away from the first claw portion by operating the operating member when the first claw portion and the second claw portion are in a closed position. and a second moving mechanism that moves the support member toward the second claw portion, wherein the support member has a gripping portion that is provided at the tip, grips the medical clip from the outside, and is biased to open outward when placed inside the sheath, and is maintained in a state of gripping the medical clip when placed inside the sheath, the operating member is biased so that the tip of the operating member opens outward, and is maintained in a state connected to the medical clip when placed inside the sheath, and the sheath is configured to be retractable from a position where the gripping portion and the tip of the operating member are placed inside the sheath to a position where the gripping portion and the tip of the operating member are exposed.

[0008] It is also preferable that the first moving mechanism has a first moving member that engages with the first claw portion and the second claw portion and moves the first claw portion and the second claw portion open and closed by moving back and forth, and that the operating member has a first operating wire whose tip is connected to the first moving member and can be operated to move the first moving member back and forth.

[0009] Furthermore, it is preferable that the second moving mechanism has a second moving member that engages with the third claw portion and moves the third claw portion toward the first claw portion and the second claw portion by moving back and forth, and that the operating member has a second operating wire whose tip is connected to the second moving member and can be operated to move the second moving member back and forth. [Effects of the Invention]

[0010] According to the present invention, it is possible to provide a medical catheter equipped with an easy-to-use medical clip that can easily suture the excised portion of a mucosal layer that has been excised over a wide area. [Brief explanation of the drawings]

[0011] [Figure 1] 1 is a perspective view showing a medical catheter according to an embodiment of the present invention. [Figure 2] FIG. 2 is a perspective view showing the medical catheter shown in FIG. 1 so that the members arranged inside the sheath can be seen. [Figure 3] FIG. 3 is an exploded perspective view showing the medical catheter shown in FIG. 2 in a disassembled state with the sheath removed. [Figure 4] 3 is a perspective view of the medical catheter shown in FIG. 2, seen from the third arm side of the medical clip. FIG. [Figure 5] FIG. 2 is a cross-sectional view taken along line AA in FIG. [Figure 6] 3 is a perspective view of the medical clip from the first arm side, showing a state in which the first and second arm portions of the medical clip have been moved to a closed position from the medical catheter shown in FIG. 2. FIG. [Figure 7] FIG. 7 is a perspective view of the medical catheter shown in FIG. 6, viewed from the third arm portion side of the medical clip. [Figure 8] 8 is a perspective view showing a state in which a third arm portion of the medical clip has been moved from the medical catheter shown in FIG. 7. FIG. [Figure 9] FIG. 9 is a perspective view showing the medical catheter shown in FIG. 8 with the sheath retracted. [Figure 10] 10 is a perspective view showing the medical catheter shown in FIG. 9 with the medical clip removed from the support member. FIG. [Figure 11] 10A to 10C are diagrams showing a procedure for suturing the excised portion of a mucosal layer that has been extensively excised using the medical catheter of one embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0012] An embodiment of the present invention will now be described with reference to the accompanying drawings. Figure 1 shows a medical catheter 1 according to one embodiment of the present invention. The medical catheter 1 of this embodiment is used to suture an ulcer floor 10 (see, for example, Figure 11) formed at the site where a lesion in the gastrointestinal mucosal layer has been excised.

[0013] In the description of this embodiment, as shown in FIG. 1 , the direction in which the tip of the first arm portion 31 and the tip of the second arm portion 32 move apart when the clip 3 of the medical catheter 1 is opened is referred to as the X direction. In the X direction, the side on which the tip of the first arm portion 31 is located is referred to as the X1 side, and the side on which the tip of the second arm portion 32 is located is referred to as the X2 side. Furthermore, the direction in which the first arm portion 31, the second arm portion 32, and the third arm portion 33 of the clip 3 of the medical catheter 1 overlap is referred to as the Y direction. In the Y direction, the side on which the first arm portion 31 is located is referred to as the Y1 side, and the side on which the third arm portion 33 is located is referred to as the Y2 side. Furthermore, the axial direction of the sheath 2 along which the sheath 2 extends is referred to as the Z direction. The tip end side of the axial direction of the sheath 2 is referred to as the Z1 side, and the rear end side of the axial direction of the sheath 2 is referred to as the Z2 side.

[0014] As shown in Figures 1 to 3, the medical catheter 1 comprises a tubular sheath 2 to be inserted into the body, a clip 3 (medical clip) provided at the tip of the sheath 2, a long support member 4 that is passed through the inside of the sheath 2 and has its tip connected to the clip 3, and a long first operating wire 51 (operating member) and a long second operating wire 52 (operating member) that are passed through the inside of the sheath 2 along the support member 4 and have their tips connected to the clip 3.

[0015] The sheath 2 is formed in a cylindrical shape and extends in the Z direction, which is the axial direction. The tip of the end of the sheath 2 on the Z1 side in the Z direction is open. The clip 3 is provided at the tip of the sheath 2 on the Z1 side. The Z2 side portion of the clip 3 is connected to the tip of the support member 4.

[0016] 2 and 3, the support member 4 is disposed inside the sheath 2. The support member 4 extends from the distal end to the proximal end of the sheath 2. The distal end of the support member 4 supports the proximal end of the clip 3. The support member 4 has a pair of gripping portions 41 provided at the distal end.

[0017] Each of the pair of gripping portions 41 has a plate-like plate portion 411 that has a thickness in the X direction and extends in the Z direction, and a bent plate 412 that bends from an end portion of the plate portion 411 on the Z1 side in the Z direction toward the clip 3. The pair of gripping portions 41 grip the base end of the clip 3 with the bent plate 412 hooked onto an end surface on the Z1 side in the Z direction of a base 341 (described later) of the clip support portion 34 of the clip 3.

[0018] The pair of gripping portions 41 grip the base end of the clip 3 from the outside. The pair of gripping portions 41 are biased in a direction that opens outward when disposed inside the sheath 2, and when disposed inside the sheath 2, they are pressed against the sheath 2, maintaining the state in which they grip the clip 3. The sheath 2 is configured so that it can be retracted toward the Z2 side in the Z direction from a position where the pair of gripping portions 41 are disposed inside the sheath 2 to a position where the gripping portions 41 are exposed, in order to release the state in which the pair of gripping portions 41 grip the clip 3 from the outside.

[0019] As shown in Figures 2 to 5, the clip 3 has a first arm portion 31 (first claw portion), a second arm portion 32 (second claw portion), a third arm portion 33 (third claw portion), a clip support portion 34, a first moving cover portion 35 (first moving mechanism portion), and a second moving cover portion 36 (second moving mechanism portion).

[0020] 3 and 5, the clip support portion 34 supports the first arm portion 31, the second arm portion 32, and the third arm portion 33. The first arm portion 31 and the second arm portion 32 are attached to the Y1 side of the clip support portion 34, and the third arm portion 33 is attached to the Y2 side of the clip support portion 34. The clip support portion 34 has a base portion 341, a support plate 342, a Y1-side protruding shaft portion 343, a Y2-side protruding shaft portion 344, and a pair of through slit grooves 345.

[0021] The base 341 is disposed at the end on the Z2 side of the clip support part 34. The support plate 342 extends toward the Z1 side from the Z1 side surface of the base 341 in the Z direction. The support plate 342 is formed in a plate shape having a thickness in the Y direction, a width in the X direction, and extends in the Z direction.

[0022] The Y1-side protruding shaft portion 343 is formed on the Y1-side surface of the support plate 342 and protrudes toward the Y1 side from a portion closer to the Z1 side than the center of the support plate 342 in the Z direction. The Y2-side protruding shaft portion 344 is formed on the Y2-side surface of the support plate 342 and protrudes toward the Y2 side from a portion closer to the Z1 side than the center of the support plate 342 in the Z direction. The pair of through slit grooves 345 are formed in the support plate 342 on the Z2 side of the Y1-side protruding shaft portion 343 and the Y2-side protruding shaft portion 344, in the shape of a groove that penetrates the support plate 342 in the Y direction and extends in the Z direction.

[0023] The first arm portion 31 and the second arm portion 32 are arranged on the Y1 side of the clip support portion 34, and are arranged adjacent to each other on the Y1 side and Y2 side in the Y direction. In the open state, the first arm portion 31 and the second arm portion 32 are arranged so that they are spaced apart in the X direction from the Z2 side to the Z1 side in the Z direction.

[0024] In the open state, the first arm portion 31 and the second arm portion 32 are formed to extend a predetermined length, symmetrically on the X1 side and the X2 side in the X direction with respect to the Z direction, which is the axial direction of the sheath 2, and tilted at the same angle toward the X1 side and the X2 side in the X direction on opposite sides. The first arm portion 31 and the second arm portion 32 have a portion where they overlap midway in the longitudinal direction, and are configured to be openable and closable by rotating about the rotation axis J.

[0025] The first arm portion 31 and the second arm portion 32 each have a plate-shaped substrate portion 311, 321 that is arranged at the base end and extends in opposite inclination directions in the Z direction, tilting toward the X1 side or the X2 side as it moves from the Z2 side to the Z1 side in the Z direction; plate-shaped narrow portions 312, 322 that are formed in a plate shape with a width narrower than the width of the substrate portions 311, 321 and extend from the substrate portions 311, 321, tilting toward each other in the Z direction, moving away from each other in the X direction as it moves from the Z2 side to the Z1 side in the Z direction; and plate-shaped gripping pieces 313, 323 that are formed by extending the tips of the narrow portions 312, 322 and have a width greater than the Y-direction thickness of the plate-shaped narrow portions 312, 322.

[0026] The first arm portion 31 and the second arm portion 32 are overlapped at portions of the base portions 311, 321 of the first arm portion 31 and the second arm portion 32 closer to the Z1 side, and a Y1-side protruding shaft portion 343 of the clip support portion 34, which supports the first arm portion 31 and the second arm portion 32 so that they can open and close, is disposed so as to penetrate the center of the overlapping portion of the first arm portion 31 and the second arm portion 32. The Y1-side protruding shaft portion 343 supports the first arm portion 31 and the second arm portion 32 so that they can rotate about the rotation axis J.

[0027] On the Z2 side of the base plate portions 311, 321 of the first arm portion 31 and the second arm portion 32, inclined long hole opening grooves 311a, 321a are formed, extending along the inclined edge formed on the sheath 2 side of the base plate portions 311, 321, at a position on the Z2 side of the portion through which the Y1 side protruding shaft portion 343 of the clip support portion 34 passes.

[0028] A protruding claw 313a having a triangular cross section and extending in the width direction of the gripping piece 313 is formed on the surface of the gripping piece 313 of the first arm portion 31 facing the gripping piece 323 of the second arm portion 32, midway in the inclined direction of the gripping piece 313. The protruding claw 323a has a triangular cross section and extends in the width direction of the gripping piece 323, formed on the surface of the gripping piece 323 of the second arm portion 32 facing the first arm portion 31, at the tip of the inclined direction of the gripping piece 323.

[0029] The first moving cover part 35 is disposed on the Y1 side in the Y direction of the first arm part 31. The first moving cover part 35 is formed to extend in the Z direction. The first moving cover part 35 has a guide groove 351 formed at the end on the Z1 side, an engagement recess 352 formed at the end on the Z2 side, and a pair of cylindrical protrusions 353 protruding from the Y2 side surface toward the Y2 side.

[0030] The guide groove 351 is formed penetrating the first moving cover part 35 in the Y direction, and extends in the shape of a slit in the Z direction from the Z1-side end of the first moving cover part 35 to the Z2 side. The Y1-side protruding shaft part 343 of the clip support part 34 is disposed in the guide groove 351, and guides the movement of the first moving cover part 35 in the Z direction when the first moving cover part 35 is moved in the Z direction.

[0031] The tip 51a of the first operation wire 51 is engaged with and connected to the engagement recess 352 at the Z2-side end of the first moving cover part 35. The engagement recess 352 has a slit recess 352a extending from the Z2-side end of the first moving cover part 35 to the Z1 side on the Y1-side surface of the first moving cover part 35, and a through-engagement hole 352b formed at the Z1-side end of the slit recess 352a in the Z direction. A linear portion of the first operation wire 51 on the near side of the tip 51a is disposed in the slit recess 352a, and the tip 51a of the first operation wire 51 is inserted into and engaged with the through-engagement hole 352b.

[0032] The first operating wire 51 has a tip 51a connected to the first moving cover part 35 and can be operated to move the first moving cover part 35 back and forth in the Z direction. The first operating wire 51 is arranged to be passed through the inside of the sheath 2 and can be operated to move in the Z direction by a hand operating part (not shown) provided on the rear end side of the sheath 2.

[0033] A tip 51a of the first operation wire 51 is coupled to an engaging recess 352 of the first moving cover part 35. The tip 51a of the first operation wire 51 is biased in a direction that opens outward, and the first operation wire 51 is disposed inside the sheath 2, whereby the first operation wire 51 is pressed against the sheath 2 and maintained in a state coupled to the first moving cover part 35. The first operation wire 51 is connected to the first moving cover part 35, and is thereby coupled to the clip 3 via the first moving cover part 35.

[0034] In order to release the state in which the tip 51 a of the first operation wire 51 is connected to the engaging recess 352 of the first moving cover part 35, the sheath 2 is configured to be able to be retracted toward the Z2 side in the Z direction from a position where the tip 51 a of the first operation wire 51 is disposed inside the sheath 2 to a position where the tip 51 a of the first operation wire 51 is exposed. The sheath 2 can be operated to retract toward the Z2 side in the Z direction by a hand operation part (not shown) provided on the rear end side of the sheath 2. When the sheath 2 is retracted toward the Z2 side in the Z direction, the first operation wire 51 opens outward, is released from the state in which it is connected to the engaging recess 352 of the first moving cover part 35, and is released from the engaging recess 352 of the first moving cover part 35.

[0035] The pair of cylindrical protrusions 353 are arranged side by side in the X direction and protrude toward the Y2 side in a portion of the Y2-side surface of the first moving cover part 35 that is closer to the Z1 side than the center in the Z direction. The pair of cylindrical protrusions 353 are arranged to penetrate the inclined elongated hole opening grooves 311a, 321a of the first arm part 31 and the second arm part 32. When the first moving cover part 35 is moved in the Z direction, the pair of cylindrical protrusions 353 move along the inclined elongated hole opening grooves 311a, 321a of the first arm part 31 and the second arm part 32, moving the first arm part 31 and the second arm part 32 to open and close.

[0036] When closing the first arm unit 31 and the second arm unit 32 from the open state, the hand operation unit (not shown) is operated to pull the first operation wire 51 toward the Z2 side from the state shown in Fig. 2, thereby moving the first movable cover unit 35 toward the Z2 side in the Z direction, as shown in Fig. 6. By moving the first movable cover unit 35 toward the Z2 side, the pair of cylindrical protrusions 353 penetrating the first arm unit 31 and the second arm unit 32 are moved toward the Z2 side, and the tip of the first arm unit 31 and the tip of the second arm unit 32 are simultaneously moved toward each other, thereby closing the first arm unit 31 and the second arm unit 32.

[0037] Furthermore, when opening the first arm portion 31 and the second arm portion 32 from a closed state, the first operating wire 51 is pushed toward the Z1 side by operating the hand-operated operating unit, thereby simultaneously moving the tip of the first arm portion 31 and the tip of the second arm portion 32 away from each other, thereby opening the first arm portion 31 and the second arm portion 32.

[0038] As described above, by operating the first operating wire 51, the first movable cover part 35 can be moved back and forth in the Z direction, and by moving the first movable cover part 35 back and forth in the Z direction, the first arm part 31 and the second arm part 32 can be simultaneously moved closer to or farther away from each other, thereby opening and closing the first arm part 31 and the second arm part 32.

[0039] 3 to 5, the third arm portion 33 is disposed on the Y2 side of the clip support portion 34. As shown in Fig. 4, the third arm portion 33 has: a plate-shaped substrate portion 331 disposed on the base end side and extending obliquely with respect to the Z direction from the X2 side toward the X1 side in the X direction as it moves from the Z2 side toward the Z1 side in the Z direction; a plate-shaped narrow portion 332 formed in a plate shape with a width narrower than the width of the substrate portion 331, extending from the substrate portion 331 and extending obliquely with respect to the Z direction at the same inclination angle as the substrate portion 331; and a plate-shaped gripping piece 333 formed by extending from the tip of the narrow portion 332 and having a width greater than the thickness in the Y direction of the plate-shaped narrow portion 332.

[0040] 4, a Y2-side protruding shaft portion 344 of the clip support portion 34 that movably supports the third arm portion 33 is disposed so as to penetrate through the Z1-side portion of the base plate portion 331 of the third arm portion 33. The Y2-side protruding shaft portion 344 supports the third arm portion 33 rotatably about the rotation axis J.

[0041] In the portion of the base plate portion 331 of the third arm portion 33 closer to the Z2 side, an inclined long hole opening groove 331a is formed, which extends along the inclined edge formed on the sheath 2 side of the base plate portion 331, at a position on the Z2 side of the portion through which the Y2 side protruding shaft portion 344 of the clip support portion 34 passes.

[0042] On the surface of the gripping piece 333 of the third arm portion 33 facing the second arm portion 32, a protruding claw 333a is formed midway in the inclined direction of the gripping piece 333, which has a triangular cross section and extends in the width direction of the gripping piece 333.

[0043] The second moving cover part 36 is disposed on the Y2 side in the Y direction of the third arm part 33. The second moving cover part 36 is formed to extend in the Z direction. The second moving cover part 36 has a guide groove 361 formed at the end on the Z1 side, an engagement recess 362 formed at the end on the Z2 side, and a pair of cylindrical protrusions 363 protruding from the Y1-side surface toward the Y1 side.

[0044] The guide groove 361 is formed penetrating the second moving cover part 36 in the Y direction, and extends in the shape of a slit in the Z direction from the Z1-side end of the second moving cover part 36 to the Z2 side. The Y2-side protruding shaft part 344 of the clip support part 34 is disposed in the guide groove 361, and guides the movement of the second moving cover part 36 in the Z direction when the second moving cover part 36 is moved in the Z direction.

[0045] The tip 52a of the second operation wire 52 is engaged with and connected to the engagement recess 362 at the Z2-side end of the second moving cover part 36. The engagement recess 362 has a slit recess 362a extending from the Z2-side end of the second moving cover part 36 to the Z1 side on the Y2-side surface of the second moving cover part 36, and a through-engagement hole 362b formed at the Z1-side end of the slit recess 362a in the Z direction. A linear portion of the second operation wire 52 on the near side of the tip 52a is disposed in the slit recess 362a, and the tip 52a of the second operation wire 52 is inserted into and engaged with the through-engagement hole 362b.

[0046] The second operating wire 52 has a tip 52a connected to the second moving cover part 36 and can be operated to move the second moving cover part 36 back and forth in the Z direction. The second operating wire 52 is arranged to be passed through the inside of the sheath 2 and can be operated to move in the Z direction by a hand operating part (not shown) provided on the rear end side of the sheath 2.

[0047] The tip 52a of the second operation wire 52 is coupled to the engaging recess 362 of the second moving cover part 36. The tip 52a of the second operation wire 52 is biased in a direction that opens outward, and the second operation wire 52 is disposed inside the sheath 2, whereby the second operation wire 52 is pressed against the sheath 2 and maintained in a state coupled to the second moving cover part 36. The second operation wire 52 is connected to the second moving cover part 36, and is thereby coupled to the clip 3 via the second moving cover part 36.

[0048] In order to release the state in which the tip 52a of the second operation wire 52 is connected to the engaging recess 362 of the second moving cover part 36, the sheath 2 is configured to be able to be retracted toward the Z2 side in the Z direction from a position where the tip 52a of the second operation wire 52 is disposed inside the sheath 2 to a position where the tip 52a of the second operation wire 52 is exposed. The sheath 2 can be operated to retract toward the Z2 side in the Z direction by a hand operation part (not shown) provided on the rear end side of the sheath 2. When the sheath 2 is retracted toward the Z2 side in the Z direction, the second operation wire 52 opens outward, is released from the state in which it is connected to the engaging recess 362 of the second moving cover part 36, and is released from the engaging recess 362 of the second moving cover part 36.

[0049] The pair of cylindrical protrusions 363 are arranged side by side in the X direction and protrude toward the Y1 side in a portion of the Y1-side surface of the second moving cover part 36 that is closer to the Z1 side than the center in the Z direction. The pair of cylindrical protrusions 363 are arranged to penetrate the inclined elongated hole opening groove 331a of the third arm part 33. When the second moving cover part 36 is moved in the Z direction, the pair of cylindrical protrusions 363 move along the inclined elongated hole opening groove 331a of the third arm part 33, moving the tip of the third arm part 33 toward the center in the X direction.

[0050] When moving the third arm section 33 closer to the first arm section 31 and the second arm section 32 from the state in which the first arm section 31 and the second arm section 32 are closed, the hand operation section (not shown) is operated from the state shown in Fig. 7 to pull the second operation wire 52 toward the Z2 side, thereby moving the second moving cover section 36 toward the Z2 side in the Z direction, as shown in Fig. 8. This allows the third arm section 33 to move closer to the first arm section 31 and the second arm section 32.

[0051] As described above, by operating the second operating wire 52 from a state in which the first arm portion 31 and the second arm portion 32 are closed, the second movable cover portion 36 can be moved back and forth in the Z direction, and by moving the second movable cover portion 36 back and forth in the Z direction, the third arm portion 33 can be moved closer to the first arm portion 31 and the second arm portion 32.

[0052] When the clip 3 provided at the tip of the sheath 2 is to be removed from the support member 4, the sheath 2 is retracted by operating a hand operation unit (not shown) as shown in Fig. 9. The sheath 2 is configured so that it can be retracted toward the Z2 side in the Z direction from a position where the pair of gripping portions 41, the tip 51a of the first operation wire 51, and the tip 52a of the second operation wire 52 are disposed inside the sheath 2, to a position where the pair of gripping portions 41, the tip 51a of the first operation wire 51, and the tip 52a of the second operation wire 52 are exposed inside the sheath 2.

[0053] As a result, by retracting the sheath 2, the pair of gripping portions 41 held by the sheath 2 are released from their gripping state and allowed to open outward, and the first operating wire 51 and the second operating wire 52 held by the sheath 2 are released from their gripping state and allowed to open outward, so that the clip 3 can be removed from the support member 4 as shown in Figure 10.

[0054] Next, how to use the clip 3 will be described. First, as shown in Figure 11(a), when an oval opening at the bottom of the ulcer 10 is formed at the site where a lesion in the gastrointestinal mucosal layer has been excised, the sheath 2 is moved closer to the bottom of the ulcer 10, and the first operating wire 51 is operated using the hand-operated operating unit to close the first arm portion 31 and the second arm portion 32, as shown in Figure 11(b), to clamp one end of the bottom of the ulcer 10.

[0055] Then, with the first arm portion 31 and the second arm portion 32 closed to clamp one end of the ulcer bottom 10, the second operating wire 52 is operated with the hand-operated unit to move the third arm portion 33 toward the first arm portion 31 and the second arm portion 32, as shown in Fig. 11(c), thereby moving the other end of the ulcer bottom 10 toward the one end, and suturing the ulcer bottom 10. After suturing the ulcer bottom 10 formed at the site where the lesion in the gastrointestinal mucosal layer was excised, the sheath 2 is retracted with the hand-operated unit as shown in Fig. 9, and the clip 3 can be removed from the support member 4 as shown in Fig. 10.

[0056] The medical catheter 1 of this embodiment described above provides the following effects. The medical catheter 1 is configured to include a tubular sheath 2, a clip 3 provided at the distal end of the sheath 2 and having a first arm portion 31, a second arm portion 32, and a third arm portion 33, and a long support member 4 whose distal end is connected to the clip 3, and the clip 3 is configured to include a first operating wire 51 and a second operating wire 52 whose distal ends 51a, 52a are connected to the clip 3, a first movable cover portion 35 which opens and closes the first arm portion 31 and the second arm portion 32 by operating the first operating wire 51, and a second movable cover portion 35 which moves the third arm portion 33 so as to approach the first arm portion 31 and the second arm portion 32. The support member 4 is configured to have a gripping section 41 that is biased in a direction that opens outward and is disposed inside the sheath 2, thereby maintaining a state in which it grips the clip 3; the first operating wire 51 and the second operating wire 52 are biased at their tips 51a, 52a to be biased in a direction that opens outward and are disposed inside the sheath 2, thereby being connected to the first moving cover section 35 and the second moving cover 36, thereby maintaining a state in which they are connected to the clip 3 via the first moving cover section 35 and the second moving cover 36; and the sheath 2 is configured to be retractable.

[0057] As a result, with the first arm 31, the second arm 32, and the third arm 33 closed to clamp one end of the ulcer base 10, the second operating wire 52 can be operated to move the third arm 33 toward the first arm 31 and the second arm 32. This allows for easy suturing of the excised portion of the mucosal layer after extensive excision. Furthermore, simply by retracting the sheath 2, the pair of gripping portions 41 held by the sheath 2 can be released and opened outward, and the first operating wire 51 and the second operating wire 52 held by the sheath 2 can be released and opened outward. This allows for easy removal of the clip 3 from the support member 4. This allows for easy suturing of the excised portion of the mucosal layer after extensive excision, and also allows for easy handling of the clip 3.

[0058] Furthermore, in this embodiment, the first moving cover part 35 is engaged with the first arm part 31 and the second arm part 32, and moves forward and backward to open and close the first arm part 31 and the second arm part 32, and the tip 51a of the first operating wire 51 is connected to the first moving cover part 35 and is operable to move the first moving cover part 35 forward and backward. Thus, by simply operating the first operating wire 51, the first moving cover part 35 moves forward and backward, and the first arm part 31 and the second arm part 32 can be easily opened and closed.

[0059] Furthermore, in this embodiment, the second moving cover part 36 is engaged with the third arm part 33 and moves the third arm part 33 toward the first arm part 31 and the second arm part 32 by moving it back and forth, and the tip 52a of the second operating wire 52 is connected to the second moving cover part 36 and is operable to move the second moving cover part 36 back and forth. As a result, by simply operating the first operating wire 51, the second moving cover part 36 moves back and forth, and the third arm part 33 can be easily moved toward the first arm part 31 and the second arm part 32.

[0060] The medical catheter and medical clip according to the present invention are not limited to those explicitly shown in this specification, and various modifications can be made thereto.

[0061] In the above embodiment, all of the components constituting the clip 3 may be made of a metal material or a biodegradable material. If all of the components constituting the clip 3 are made of a biodegradable material, the biodegradable material will decompose over time in the body, making it unnecessary to remove the clip from the body. [Explanation of symbols]

[0062] 1. Medical catheters 2 sheath 3 Clips (medical clips) 4 Support member 31 First arm part (first claw part) 32 Second arm part (second claw part) 33 Third arm part (third claw part) 35 First moving cover part (first moving member, first moving mechanism part) 36 Second moving cover part (second moving member, second moving mechanism part) 41 Gripping part 51 First operating wire (operating member) 52 Second operating wire (operating member)

Claims

1. a tubular sheath that is inserted into the body; a medical clip provided at a distal end of the sheath and having a first claw portion, a second claw portion, and a third claw portion; a long support member that is passed through the inside of the sheath and has a tip connected to the medical clip; a long operating member that is passed through the inside of the sheath along the support member and has a tip connected to the medical clip; The medical clip comprises: a first movement mechanism that operates the operating member to simultaneously move the first claw portion and the second claw portion toward or away from each other, thereby opening and closing the first claw portion and the second claw portion; a second movement mechanism that moves the third claw toward the first claw and the second claw by operating the operating member when the first claw and the second claw are located in a closed position, the support member has a gripping portion provided at a distal end, which grips the medical clip from the outside, and which is biased to open outward when placed inside the sheath, and which is maintained in a state of gripping the medical clip when placed inside the sheath; The operating member is biased in a direction in which a tip of the operating member opens outward, and is disposed inside the sheath, thereby maintaining a state in which the operating member is connected to the medical clip, A medical catheter, wherein the sheath is configured to be retractable from a position where the gripping portion and the tip of the operating member are disposed inside the sheath to a position where the gripping portion and the tip of the operating member are exposed.

2. the first moving mechanism includes a first moving member that is engaged with the first claw portion and the second claw portion and moves forward and backward to open and close the first claw portion and the second claw portion, The medical catheter according to claim 1 , wherein the operating member has a first operating wire whose tip is connected to the first moving member and which can be operated to move the first moving member back and forth.

3. the second moving mechanism includes a second moving member that is engaged with the third claw portion and moves back and forth to move the third claw portion toward the first claw portion and the second claw portion, 3. The medical catheter according to claim 1, wherein the operating member has a second operating wire whose tip is connected to the second moving member and which can be operated to move the second moving member back and forth.

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