Medical clip and medical catheter

Abstract

To provide a medical clip and a medical catheter 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 clip 3 includes: a first clip 31 energized on the side where an end side of a pair of first claw parts 311 are openable / closable; a second clip 32 which is disposed in parallel to the first clip 31 and energized on the side where an end side of a pair of second claw parts 321 are openable / closable; and a holding part 33 which has through openings 331, 332 which a part on a base end side of the first clip 31 and a part on a base end side of the second clip 32 pass and hold the first clip 31 and the second clip 32 openably / closably.SELECTED DRAWING: Figure 2

Description

[Technical Field]

[0001] The present invention relates to a medical clip and 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 clip and a medical catheter that can easily suture the excised portion of a mucosal layer that has been excised over a wide area, and that are easy to handle. [Means for solving the problem]

[0007] The present invention relates to a medical clip comprising: a first clip having a pair of first claw portions connected at their base ends, with the distal ends of the pair of first claw portions biased to open in an openable / closable state; a second clip arranged in parallel to the first clip, having a pair of second claw portions connected at their base ends, with the distal ends of the pair of second claw portions biased to open in an openable / closable state; and a holding portion having a through opening through which the proximal end portions of the first clip and the proximal end portions of the second clip pass, and which holds the first clip and the second clip in an openable / closable state.

[0008] Furthermore, it is preferable that the holding portion is configured so that by passing the base end portion of the first clip and the base end portion of the second clip through the through opening and moving them rearward, the pair of first claw portions or the pair of second claw portions can be moved closer to each other and closed against the biasing force by the through opening.

[0009] The present invention also relates to a medical clip comprising: a third clip having a pair of third claws whose base ends are connected to each other, and whose tip ends are biased to open in an openable state; a fourth clip having a pair of fourth claws whose base ends are connected to each other, and whose tip ends are biased to open in an openable state; a first support part connected to the base end of the third clip and supporting the third clip; a second support part connected to the base end of the fourth clip and supporting the fourth clip, the second support part being tubular and located outside the first support part, and configured to be movable relative to the third clip so that the third clip is drawn into the tubular part and the third clip is moved in the closing direction; and a cylindrical operating tube part located outside the second support part, and configured to be movable relative to the fourth clip so that the fourth clip is drawn into the tubular part and the fourth clip is moved in the closing direction.

[0010] and 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 and that is operated to move a base-end portion of the first clip and a base-end portion of the second clip. The support member has a gripping portion that is provided at the tip and grips the medical clip from the outside, and is biased to open outward when placed inside the sheath, and is placed inside the sheath to maintain the state of gripping the medical clip. The tip of the operating member is biased to open outward, and is placed inside the sheath to maintain a state connected to the medical clip. The sheath is preferably 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. [Effects of the Invention]

[0011] According to the present invention, it is possible to provide a medical clip and a medical catheter that can easily suture the excised portion of a mucosal layer that has been excised over a wide area and that are easy to handle. [Brief explanation of the drawings]

[0012] [Figure 1] 1 is a perspective view showing a medical catheter according to a first 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] 3 is a perspective view showing a state in which a support member is removed from the medical catheter shown in FIG. 2. FIG. [Figure 4] 1 is an exploded perspective view of a medical clip according to a first embodiment of the present invention. [Figure 5] 3 is a perspective view of the medical catheter shown in FIG. 2, viewed from the first clip side of the medical clip. FIG. [Figure 6] FIG. 10 is a perspective view showing a state in which the first clip has been moved to a closed position. [Figure 7] 7 is a perspective view showing a state in which the second clip has been moved to a closed position from the state shown in FIG. 6. FIG. [Figure 8] FIG. 8 is a perspective view showing the medical catheter shown in FIG. 7 with the sheath retracted. [Figure 9] 9 is a perspective view showing the medical catheter shown in FIG. 8 with the medical clip removed from the support member. FIG. [Figure 10] 1A to 1C are diagrams showing a procedure for suturing the excised portion of a mucosal layer that has been excised over a wide area using the medical catheter of the first embodiment of the present invention. [Figure 11] FIG. 1 is a perspective view showing a medical catheter according to a second embodiment of the present invention. [Figure 12] FIG. 10 is an exploded perspective view of a medical clip according to a second embodiment of the present invention. [Figure 13] FIG. 12 is a cross-sectional view taken along line AA in FIG. [Figure 14] FIG. 12 is a cross-sectional view taken along line BB in FIG. [Figure 15] FIG. 10 is a perspective view showing the inner clip moved to a closed position. [Figure 16] 16 is a perspective view showing a state in which the outer clip has been moved to a closed position from the state shown in FIG. 15. FIG. [Figure 17] 10A to 10C are diagrams showing a procedure for suturing the excised portion of a mucosal layer that has been excised over a wide area using the medical catheter of the second embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0013] A first embodiment of the present invention will now be described with reference to the accompanying drawings. Fig. 1 shows a medical catheter 1 according to the first embodiment of the present invention. The medical catheter 1 of this embodiment is used to suture an ulcer base 10 (see, for example, Fig. 10) formed at the site where a lesion in the gastrointestinal mucosal layer has been excised.

[0014] In the description of this embodiment, as shown in FIG. 2 , the direction in which the tips of the pair of first arm portions 311 of the first clip 31 and the tips of the pair of second arm portions 321 of the second clip 32 move apart when the clip 3 of the medical catheter 1 is open is referred to as the X direction. In the X direction, one side is referred to as the X1 side, and the other side is referred to as the X2 side. The direction in which the first clip 31 and the second clip 32 are aligned is referred to as the Y direction. In the Y direction, the side on which the first clip 31 is arranged is referred to as the Y1 side, and the side on which the second clip 32 is arranged is referred to as the Y2 side. 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.

[0015] 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.

[0016] 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.

[0017] 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.

[0018] 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 C-shaped hook plate 412 that is disposed at the end of the plate portion 411 on the Z1 side in the Z direction and opens inward in the X direction. The pair of gripping portions 41 grip the base end of the clip 3 by hooking the hook plate 412 onto the end surface on the Z1 side in the Z direction of a clip holding portion 33 (described later) of the clip 3.

[0019] 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.

[0020] As shown in FIGS. 2 to 5, the clip 3 has a first clip 31, a second clip 32, and a clip holding portion 33 (holding portion). In the open state, the first clip 31 and the second clip 32 are both arranged so as to be spaced apart in the X direction from the Z2 side to the Z1 side in the Z direction. In the open state, the first clip 31 and the second clip 32 are both formed in a generally V-shape with their base ends connected to each other and their tip ends open, and are formed in a symmetrical shape on the X1 side and the X2 side in the X direction. As shown in FIGS. 1 to 5, the first clip 31 and the second clip 32 are arranged side by side on the Y1 side and the Y2 side in the Y direction.

[0021] The first clip 31 has a pair of arm portions 311 (first claw portions) and a connecting portion 312 that connects the base ends of the pair of arm portions 311 together. The first clip 31 is configured so that the tip ends of the pair of arm portions 311 are biased to open in an openable / closable state, and open in a substantially V-shape due to elastic force. The first clip 31 is formed of, for example, a metal material.

[0022] As shown in FIG. 4, each of the pair of arms 311 has a curved plate portion 311a, an inclined linear portion 311b, and a gripping piece 311c. The pair of curved plate portions 311a extend from the connecting portion 312 toward the Z1 side in the Z direction, with their tips inclined and curved toward the sides separating in the X direction. The pair of inclined linear portions 311b extend linearly from the Z1-side end of each of the pair of curved plate portions 311a, with their tips inclined and curved toward the sides separating in the X direction, with their tips inclined and curved toward the Z1 side in the Z direction. The pair of gripping pieces 311c protrude from the Z1-side end of each of the pair of inclined linear portions 311b, with their tips inclined toward the diagonal Z1 side toward the opposing arm portion 311. The pair of gripping pieces 311c of the pair of arms 311 are positioned opposite each other when the pair of arms 311 are closed.

[0023] A triangular recessed claw 311d that is recessed in a triangular shape is formed on the gripping piece 311c of the arm portion 311 on the X1 side of the pair of arm portions 311. A triangular protruding claw 311e that protrudes in a triangular shape is formed on the gripping piece 311c of the arm portion 311 on the X2 side of the pair of arm portions 311.

[0024] The connecting portion 312 connects the base ends of the pair of arm portions 311 to each other. The connecting portion 312 is formed continuously with the Z2-side ends of the pair of arm portions 311, and is formed in an arc shape that is open on the Z1 side. A through opening 312a that penetrates the connecting portion 312 in the Y direction is formed. The tip end 51a of the first operating wire 51 is connected to the through opening 312a.

[0025] The first operating wire 51 is connected to the connecting portion 312 by being inserted into the through opening 312a of the connecting portion 312 of the first clip 31 from the outside of the Y1 side of the through opening 312a of the connecting portion 312 of the first clip 31. The first operating wire 51 is biased such that the tip 51a opens outward, and is arranged inside the sheath 2, so that the first operating wire 51 is pressed against the sheath 2 and maintained in a state connected to the first clip 31.

[0026] The first operating wire 51 has a tip 51a connected to the connecting portion 312 and is configured to be able to move the first clip 31 back and forth in the Z direction. The first operating wire 51 is disposed by being passed through the inside of the sheath 2 and can be operated to move it in the Z direction by a hand operating portion (not shown) provided on the rear end side of the sheath 2. The first operating wire 51 is operated to move the proximal end side portion of the first clip 31.

[0027] In order to release the state in which the tip 51a of the first operating wire 51 is connected to the connection portion 312 of the first clip 31, 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 51a of the first operating wire 51 is disposed inside the sheath 2 to a position where the tip 51a of the first operating wire 51 is exposed. The sheath 2 can be operated to retract toward the Z2 side in the Z direction by a hand operating unit (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 operating wire 51 opens outward, is released from its connection to the first clip 31, and is released from the first clip 31.

[0028] The second clip 32 is formed in the same shape as the first clip 31, except that the shapes of the pair of gripping pieces 321c are swapped with the shapes of the pair of gripping pieces 311c of the first clip 31. The second clip 32 is arranged in parallel to the first clip 31 on the Y2 side in the Y direction. The second clip 32 has a pair of arm portions 321 (second claw portions) and a connecting portion 322 that connects the base ends of the pair of arm portions 321. The second clip 32 is configured so that the tip ends of the pair of arm portions 321 are biased toward the opening side in an openable / closable state, and open in a substantially V-shape due to elastic force. The second clip 32 is formed, for example, from a metal material.

[0029] As shown in FIG. 4, each of the pair of arms 321 has a curved plate portion 321a, an inclined linear portion 321b, and a gripping piece 321c. The pair of curved plate portions 321a extend from the connecting portion 322 toward the Z1 side in the Z direction, with their tips inclined and curved toward the sides separating in the X direction. The pair of inclined linear portions 321b extend linearly from the Z1-side end of each of the pair of curved plate portions 321a, with their tips inclined and curved toward the sides separating in the X direction as they extend toward the Z1 side in the Z direction. The pair of gripping pieces 321c protrude from the Z1-side end of each of the pair of inclined linear portions 321b, with an inclination toward the diagonal Z1 side toward the opposing arm portion 321. The pair of gripping pieces 321c of the pair of arms 321 are positioned opposite each other when the pair of arms 321 are closed.

[0030] Of the pair of arm portions 321, a triangular protruding claw 321e that protrudes in a triangular shape is formed on the gripping piece 321c of the arm portion 321 on the X1 side. Of the pair of arm portions 321, a triangular recessed claw 321d that is recessed in a triangular shape is formed on the gripping piece 321c of the arm portion 321 on the X2 side.

[0031] The connecting portion 322 connects the base ends of the pair of arm portions 321 to each other. The connecting portion 322 is formed continuously with the Z2-side ends of the pair of arm portions 321, and is formed in an arc shape that is open on the Z1 side. A through opening 322a that penetrates in the Y direction is formed in the connecting portion 322. A tip end 52a of the second operating wire 52 is connected to the through opening 322a.

[0032] The second operating wire 52 is connected to the connecting portion 322 by being inserted into the through opening 322a of the connecting portion 322 of the second clip 32 from the outside of the Y2 side of the through opening 322a of the connecting portion 322 of the second clip 32. The second operating wire 52 is biased such that the tip 52a opens outward, and is arranged inside the sheath 2, so that the second operating wire 52 is pressed against the sheath 2 and maintained in a state connected to the second clip 32.

[0033] The second operating wire 52 has a tip 52a connected to the connecting portion 322 and is configured to be able to move the second clip 32 back and forth in the Z direction. The second operating wire 52 is disposed by being passed through the inside of the sheath 2 and can be operated to move it in the Z direction by a hand operating portion (not shown) provided on the rear end side of the sheath 2. The second operating wire 52 is operated to move the proximal end side portion of the second clip 32.

[0034] In order to release the state in which the tip 52a of the second operating wire 52 is connected to the connecting portion 322 of the second clip 32, 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 operating wire 52 is disposed inside the sheath 2 to a position where the tip 52a of the second operating wire 52 is exposed. The sheath 2 can be operated to retract toward the Z2 side in the Z direction by a hand operating unit (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 operating wire 52 opens outward, is released from its connection to the second clip 32, and is detached from the second clip 32.

[0035] The clip holding portion 33 holds the base end portion of the first clip 31 and the base end portion of the second clip 32, thereby holding the first clip 31 and the second clip 32 openably and closably. The clip holding portion 33 has two through openings, a first through opening 331 (through opening) and a second through opening 332 (through opening), which penetrate in the Z direction. The first through opening 331 and the second through opening 332 are arranged side by side in the Y direction.

[0036] The first through opening 331 is formed on the Y1 side in the Y direction. The connecting portion 312 on the base end side of the first clip 31 is passed through the first through opening 331. The connecting portion 312 on the base end side of the first clip 31 is disposed through the first through opening 331 from the Z1 side to the Z2 side in the Z direction.

[0037] The second through opening 332 is formed on the Y2 side in the Y direction. The connecting portion 322 on the base end side of the second clip 32 is passed through the second through opening 332. The connecting portion 322 on the base end side of the second clip 32 is disposed through the second through opening 332 from the Z1 side to the Z2 side in the Z direction.

[0038] When the connection portion 312 on the base end side of the first clip 31 and the connection portion 322 on the base end side of the second clip 32 are arranged through the first through opening 331 and the second through opening 332, the connection portion 312 of the first clip 31 and the connection portion 322 of the second clip 32 penetrate the clip holding portion 33 from the Z1 side to the Z2 side in the Z direction and are arranged protruding toward the Z2 side of the clip holding portion 33.

[0039] The clip holding portion 33 holds the first clip 31 in a state in which the base end connection portion 312 of the first clip 31 is moved rearward (toward the Z2 side) while passing through the first through opening 331, thereby moving the pair of arm portions 311 of the first clip 31 from the Z1 side to the Z2 side in the Z direction in the narrowed portion of the first through opening 331 by the first through opening 331, and allowing the pair of arm portions 311 to move closer to each other against the biasing force and toward the closing side.

[0040] Similarly, the clip holding portion 33 holds the second clip 32 in a state in which the base end connection portion 322 of the second clip 32 is moved rearward (toward the Z2 side) while passing through the second through opening 332, thereby moving the pair of arm portions 321 of the second clip 32 from the Z1 side to the Z2 side in the Z direction in the narrowed portion of the second through opening 332 by the second through opening 332, and moving the pair of arm portions 321 toward each other and closing them against the biasing force.

[0041] This allows the base end connection portion 312 of the first clip 31 to be placed through the first through opening 331 and the base end connection portion 322 of the second clip 32 to be placed through the second through opening 332, and then the base end portion of the first clip 31 or the base end portion of the second clip 32 to be moved rearward (toward Z2), thereby opening and closing the first clip 31 or the second clip 32.

[0042] When the connection portion 312 of the first clip 31 is disposed so as to penetrate through the first through-opening 331 of the clip holding portion 33, the tip 51a of the first operation wire 51 is inserted into the connection portion 312 of the first clip 31. When the connection portion 322 of the second clip 32 is disposed so as to penetrate through the second through-opening 332 of the clip holding portion 33, the tip 52a of the second operation wire 52 is inserted into the connection portion 322 of the second clip 32.

[0043] To open or close the first clip 31, with the first clip 31 in the open state shown in FIG. 2, the handheld operation unit (not shown) is operated to pull the first operating wire 51 toward the Z2 side, thereby moving the first clip 31 toward the Z2 side in the Z direction, as shown in FIG. 6. This moves the first clip 31 toward the Z2 side at the narrowed portion of the first through-opening 331 of the clip holding unit 33, and moves the pair of arm portions 311 toward each other against the biasing force, toward the closing side. This moves the first clip 31 toward the closing side. To open the first clip 31 from this state, the first operating wire 51 is returned to the Z1 side, thereby moving the first clip 31 toward the opening side.

[0044] To open or close the second clip 32, with the second clip in the open state shown in FIG. 6, the second operating wire 52 is pulled toward the Z2 side by operating the handheld operating unit (not shown). As a result, the second clip 32 is moved toward the Z2 side in the Z direction, as shown in FIG. 7, whereby the second clip 32 is moved toward the Z2 side at the narrowed portion of the second through-opening 332 of the clip holding portion 33, and the pair of arm portions 321 are moved toward each other against the biasing force, toward the closing side. This moves the second clip 32 toward the closing side. To open the second clip 32 from this state, the second operating wire 52 is returned toward the Z1 side, thereby moving the second clip 32 toward the opening side.

[0045] 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. 8. The sheath 2 is configured so as to be retractable 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.

[0046] 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 9.

[0047] Next, how to use the clip 3 will be described. First, as shown in Figure 10(a), when an oval opening at the bottom of an ulcer 10 is formed at the site where a lesion in the gastrointestinal mucosal layer has been excised, the sheath 2 is moved toward the bottom of the ulcer 10 with the first clip 31 and the second clip 32 of the clip 3 closed, and when the clip 3 reaches the bottom of the ulcer 10, both the first clip 31 and the second clip 32 are opened by operating the hand-operated operating unit, as shown in Figure 10(a). Thereafter, the first operating wire 51 is operated by the hand-operated operating unit to close the first clip 31 of the clip 3 and clamp one end of the bottom of the ulcer 10, as shown in Figure 10(b).

[0048] Then, with the first clip 31 closed to clamp one end of the ulcer bottom 10, the second operating wire 52 is operated with the hand-operated unit to close the second clip 32, as shown in Fig. 10(c), and move the other end of the ulcer bottom 10 toward the one end, thereby 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. 8, and the clip 3 can be removed from the support member 4 as shown in Fig. 9.

[0049] The clip 3 and medical catheter 1 of this embodiment described above provide the following advantages. The clip 3 is configured to include a first clip 31 in which the distal ends of a pair of arms 311 are biased to open in an openable / closable state, a second clip 32 arranged in parallel to the first clip 31 and the distal ends of a pair of arms 321 are biased to open in an openable / closable state, and a clip holder 33 having a first through opening 331 and a second through opening 332 through which the proximal end portions of the first clip 31 and the second clip 32 are passed, and which holds the first clip 31 and the second clip 32 in an openable / closable state. With this configuration, by closing the first clip 31 to clamp one end of the ulcer bottom 10, and then closing the second clip 32 to bring the other end of the ulcer bottom 10 together, the excised portion of the mucosal layer that has been excised over a wide area can be easily sutured.

[0050] In this embodiment, by moving the holding portion 33 rearward with the proximal portion of the first clip 31 and the proximal portion of the second clip 32 passing through the first through opening 331 and the second through opening 332, the pair of arms 311 or the pair of arms 321 can be moved toward each other and closed against the biasing force by the first through opening 331 and the second through opening 332. As a result, the first clip 31 and the second clip 32 can be opened and closed simply by moving the proximal portion of the first clip 31 and the proximal portion of the second clip 32 rearward. With the first clip 31 closed to clamp one end of the ulcer bottom 10, the other end of the ulcer bottom 10 can be easily brought together by closing the second clip 32, thereby facilitating the suturing of the excised portion of the mucosal layer that has been extensively excised.

[0051] In this embodiment, the medical catheter 1 is configured to include a tubular sheath 2, a clip 3 provided at the tip of the sheath 2, a long support member 4 whose tip is connected to the clip 3, and long first and second operating wires 51 and 52 whose tips 51a, 52a are connected to the clip 3. The support member 4 is configured to have a gripping portion 41 that is held in a state of gripping the clip 3 when it is biased in a direction that opens outward and placed inside the sheath 2. The first and second operating wires 51 and 52 are held connected to the clip 3 when they are biased in a direction that opens outward and placed inside the sheath 2, and the sheath 2 is configured to be able to be retracted.

[0052] As a result, simply by retracting the sheath 2, the pair of gripping portions 41 held by the sheath 2 can be released from their gripping state and opened outward, and the first operating wire 51 and the second operating wire 52 held by the sheath 2 can be released from their gripping state and opened outward, allowing the clip 3 to be easily removed from the support member 4. Therefore, a medical catheter 1 can be provided that is equipped with an easy-to-handle clip 3.

[0053] Next, a second embodiment of the present invention will be described with reference to the accompanying drawings. Fig. 11 shows a medical catheter 1A according to the second embodiment of the present invention. Like the medical catheter 1 of the first embodiment, the medical catheter 1A of the second embodiment is used to suture an ulcer base 10A (see, for example, Fig. 17) formed at the site where a lesion in the gastrointestinal mucosal layer has been excised. In the second embodiment, components similar to those of the first embodiment are designated by similar reference numerals, and description thereof will be omitted.

[0054] In the description of this embodiment, as shown in FIG. 11 , the direction in which the tips of the pair of arm portions 611 of the inner clip 61 and the tips of the pair of arm portions 621 of the outer clip 62 move apart when the clip 6 of the medical catheter 1A is opened is referred to as the X direction. In the X direction, one side is referred to as the X1 side, and the other side is referred to as the X2 side. Furthermore, the direction in which the rotation axis extends when the pair of arm portions 611 of the inner clip 61 and the pair of arm portions 621 of the outer clip 62 rotate around the rotation axis to open and close is referred to as the Y direction. In the Y direction, one side is referred to as the Y1 side, and the other side is referred to as the Y2 side. The axial direction of the operating tube portion 65 along which the operating tube portion 65 extends is referred to as the Z direction. The tip end side of the axial direction of the operating tube portion 65 is referred to as the Z1 side, and the rear end side of the axial direction of the operating tube portion 65 is referred to as the Z2 side.

[0055] The medical catheter 1A of the second embodiment includes a clip 6 (medical clip) shown in FIG. 11, and is provided at the distal end of the sheath 2 shown in the first embodiment of FIG. 1, as in the first embodiment. In the second embodiment, illustration of components other than the clip 6 is omitted. In the second embodiment, the components other than the clip 6 (for example, the components of the sheath 2, support member 4, gripping portion 41, first operating wire 51, second operating wire 52 (operating members) of the first embodiment) can be applied to the components of the first embodiment. The description of the first embodiment is used to explain the components other than the clip 6.

[0056] As shown in Figures 11 to 14, the clip 6 has an inner clip 61 (third clip), an outer clip 62 (fourth clip), a first support portion 63 that supports the base end side of the inner clip 61, a second support portion 64 that supports the base end side of the outer clip, and an operating tube portion 65.

[0057] When both the inner clip 61 and the outer clip 62 are closed, the inner clip 61 is disposed on the inside and the outer clip 62 is disposed on the outside (see FIG. 16). In the open state, the inner clip 61 and the outer clip 62 are disposed so as to be spaced apart in the X direction from the Z2 side to the Z1 side in the Z direction, as shown in FIG.

[0058] 11, the inner clip 61 has a pair of arm portions 611 (third claw portions) whose base ends are connected to each other. Each of the pair of arm portions 611 is formed in a rod shape curved so as to convex outward, and has a tip-side protruding piece 611a at its tip end that protrudes toward the other arm portion 611 of the pair of arm portions 611 in the Y direction. The tip ends of the pair of arm portions 611, including the pair of tip-side protruding pieces 611a, are arranged opposite each other when the pair of arm portions 611 are closed (see FIG. 16).

[0059] The inner clip 61 is configured such that the tip ends of the pair of arm portions 611 are biased to open in an openable and closable state, and open in a substantially V-shape by elastic force. The inner clip 61 is formed of, for example, a metal material.

[0060] The base ends of the pair of arm portions 611 are connected to the tips of the first support portion 63. The end portion of the first support portion 63 on the Z1 side in the Z direction is connected to the base end side of the inner clip 61 and supports the base end side of the inner clip 61. The first support portion 63 extends from the base end sides of the pair of arm portions 611 to the Z2 side in the Z direction.

[0061] 12 to 14, the first support portion 63 has a support frame portion 631 and an extending plate portion 632 extending toward the Z2 side from the Z2-side end portion in the Z direction of the support frame portion 631. The support frame portion 631 has a rectangular frame-shaped hollow frame portion 631a that penetrates in the X direction, and a pair of mounting plate portions 631b that protrude toward the Z1 side from both ends in the Y direction at the Z1-side end portion of the hollow frame portion 631a.

[0062] Between the pair of mounting plate portions 631b, the base end portions of the pair of arm portions 611 are arranged in a state where they are overlapped in the Y direction, and are rotatably supported by shaft members 631c that penetrate in the Y direction. This allows the pair of arm portions 611 to rotate around a rotation axis that extends in the Y direction and is the central axis of the shaft members 631c that are supported at the base end portions. The extending plate portion 632 is formed in a plate shape that has a thickness in the Y direction and a width in the X direction, and extends to the Z2 side from the center in the Y direction at the Z2 side end portion of the hollow frame portion 631a.

[0063] As shown in Fig. 11, the outer clip 62 has a pair of arm portions 621 (fourth claw portions) whose base ends are connected to each other via the second support portion 64. Each of the pair of arm portions 621 is formed in a rod shape that is curved so as to convex outward. The pair of arm portions 621 is formed to be longer than the pair of arm portions 611 of the inner clip 61. The tips of the pair of arm portions 621 are arranged opposite each other when the pair of arm portions 621 are closed (see Fig. 16).

[0064] When both the pair of arm portions 611 of the inner clip 61 and the pair of arm portions 621 of the outer clip 62 are closed, the pair of arm portions 621 are arranged along the outer sides in the X direction of the pair of arm portions 611 of the inner clip 61 so as to cover the outer sides in the X direction and the Z1 side in the Z direction of the pair of arm portions 611 of the inner clip 61 in the closed state, as shown in FIG.

[0065] 11, the outer clip 62 is configured such that the distal ends of a pair of arms 621 are biased toward the opening side in an openable and closable state, and open in a substantially V-shape by elastic force. The outer clip 62 is formed, for example, from a metal material. The proximal ends of the pair of arms 621 are connected to the distal ends of the second support portion 64. The second support portion 64 is connected to the proximal end of the outer clip 62 and supports the proximal end of the outer clip 62.

[0066] The second support portion 64 is formed in a cylindrical shape and disposed outside the first support portion 63. The second support portion 64 is configured so that, when moved toward the inner clip 61, the second support portion 64 moves relative to the inner clip 61. By moving the second support portion 64 toward the Z1 side in the Z direction, the pair of arm portions 611 of the inner clip 61 are pulled into the interior of the cylindrical portion of the cylindrical portion 641 of the second support portion 64, and the pair of arm portions 611 are moved toward each other against the biasing force, thereby moving the inner clip 61 toward the closing side. The second support portion 64 extends toward the Z2 side in the Z direction from the base end sides of the pair of arm portions 621.

[0067] As shown in Figures 12 to 14, the second support portion 64 has a cylindrical portion 641, a narrow cylindrical portion 642, and a pair of mounting frame portions 643. The cylindrical portion 641 is formed in a cylindrical shape that is rectangular in cross section and extends in the Z direction. The narrow cylindrical portion 642 extends toward the Z2 side from the end of the cylindrical portion 641 on the Z2 side in the Z direction. The narrow cylindrical portion 642 is formed in a cylindrical shape that has the same width in the X direction as the cylindrical portion 641 and is narrow in the Y direction.

[0068] The cylindrical portion 641 and the narrow cylindrical portion 642 are arranged in this order from the Z1 side to the Z2 side in the Z direction, with their internal spaces communicating with each other. A first support portion 63 that supports the inner clip 61 is arranged in the internal space between the cylindrical portion 641 and the narrow cylindrical portion 642 so as to be movable in the Z direction.

[0069] The pair of mounting frames 643 are provided on the respective outer side surfaces of both ends in the X direction of the cylindrical portion 641. Each of the pair of mounting frames 643 has a vertically elongated opening frame 643a that extends in the Z direction along the respective outer side surfaces of both ends in the X direction of the cylindrical portion 641 and that opens outward in the X direction, and a pair of mounting pieces 643b that are provided so as to protrude toward the Z1 side from the upper end of the vertically elongated opening frame 643a.

[0070] The base end portions of the pair of arm portions 621 are disposed between the pair of mounting pieces 643b and are rotatably supported by shaft members 643c that penetrate in the Y direction. This allows arm portion 621 to rotate around a rotation axis that extends in the Y direction and is the central axis of shaft members 643c that are supported at the base end portions.

[0071] An operating wire (not shown) is connected to the Z2 side of the second support part 64, and an operation to push the second support part 64 toward the Z1 side or an operation to pull the second support part 64 toward the Z2 side can be performed using a hand-operated operating part (not shown). As a result, by operating the hand-operated operating part (not shown), the second support part 64 can be moved relative to the inner clip 61, and the second support part 64 can be moved in the Z direction.

[0072] 11 and 12, the operation tube portion 65 is formed in a cylindrical shape and disposed outside the second support portion 64. The operation tube portion 65 is configured so that, when moved toward the outer clip 62, the operation tube portion 65 moves relative to the outer clip 62. By moving the operation tube portion 65 to the Z1 side in the Z direction, the pair of arm portions 621 of the outer clip 62 are pulled into the inside of the cylindrical portion of the operation tube portion 65, and the pair of arm portions 621 are moved toward each other against the biasing force, thereby moving the outer clip 62 toward the closing side. The operation tube portion 65 has a tube portion main body 651 and a pair of inner surface restricting protrusions 652 (see FIG. 13).

[0073] The tubular body 651 is formed in a tubular shape that is rectangular in cross section and extends in the Z direction. A second support part 64 that supports the outer clip 62 is arranged in an internal space that penetrates the tubular body 651 in the Z direction so as to be movable in the Z direction. An operation wire (not shown) is connected to the Z2 side of the control tubular part 65, and the control tubular part 65 can be pushed or pulled toward the Z2 side by a hand-operated operation part (not shown). As a result, by operating the hand-operated operation part (not shown), the control tubular part 65 can be moved relative to the outer clip 62, and the control tubular part 65 can be moved in the Z direction.

[0074] 13, the pair of inner surface restricting protrusions 652 are formed to protrude inward from the inner surface of the tubular main body 651 at a midpoint in the Z direction. When the second support portion 64 moves toward the Z1 side in the Z direction in the internal space of the tubular main body 651, the pair of inner surface restricting protrusions 652 restrict the second support portion 64 from moving further toward the Z1 side in the Z direction than a wall portion formed at the Z2-side end of the vertically elongated opening frame portion 643a of the mounting frame portion 643 of the second support portion 64.

[0075] To open or close the inner clip 61, with the inner clip 61 in the open state shown in Fig. 11, an operation wire (not shown) is operated by operating a hand operation unit (not shown) that operates the second support portion 64 to push the second support portion 64 toward the Z1 side. As shown in Fig. 15, by moving the second support portion 64 toward the Z1 side in the Z direction, the second support portion 64 is moved relative to the inner clip 61, and the pair of arm portions 611 of the inner clip 61 are pulled from the base end side into a narrowed portion of the internal opening of the tubular portion 641 of the second support portion 64, and move closer to each other against the biasing force of the pair of arm portions 611 toward the closing side. In this way, by moving the second support portion 64 toward the Z1 side, the inner clip 61 is moved toward the closing side. Furthermore, when opening the inner clip 61 from this state, the second support part 64 is moved to the Z2 side in the Z direction by operating the hand-operated operating part (not shown) that operates the second support part 64 to pull the operating wire (not shown) toward the Z2 side, and the second support part 64 is retracted to the Z2 side, and the inner clip 61 is moved to the opening side by the force of the pair of arm parts 611.

[0076] To open or close the outer clip 62, with the outer clip 62 in the open state shown in Fig. 15, an operation wire (not shown) is operated by operating a hand operation unit (not shown) that operates the operation tube portion 65 to push the operation tube portion 65 toward the Z1 side. As shown in Fig. 16, by moving the operation tube portion 65 toward the Z1 side in the Z direction, the operation tube portion 65 is moved relative to the outer clip 62, and the pair of arm portions 621 of the outer clip 62 are pulled from the base end side into the narrowed portion of the opening inside the tube body 651 of the operation tube portion 65, and move closer to each other against the biasing force of the pair of arm portions 621 toward the closing side. In this way, by moving the operation tube portion 65 toward the Z1 side, the outer clip 62 is moved toward the closing side. Furthermore, when opening the outer clip 62 from this state, the operating wire (not shown) is pulled toward the Z2 side by operating the hand-operated operating unit (not shown) that operates the operating tube portion 65, thereby moving the operating tube portion 65 toward the Z2 side in the Z direction, causing the operating tube portion 65 to retreat toward the Z2 side, and the outer clip 62 is moved toward the opening side by the force of the pair of arm portions 621.

[0077] Next, how to use the clip 6 will be described. First, as shown in Figure 17(a), when an oval opening at the bottom of an ulcer 10A is formed at the site where a lesion in the gastrointestinal mucosal layer has been resected, the clip 6 attached to the tip of a sheath (not shown) is moved toward the bottom of the ulcer 10A with the inner clip 61 and outer clip 62 of the clip 6 closed, and when the clip 6 reaches the bottom of the ulcer 10A, both the inner clip 61 and the outer clip 62 are opened by operating the hand-operated operating unit, as shown in Figure 17(a). Then, the operating wire (not shown) is operated by the hand-operated operating unit that operates the second support part 64, and the inner clip 61 of the clip 6 is closed to clamp one end of the bottom of the ulcer 10A, as shown in Figure 17(b).

[0078] Then, with the inner clip 61 closed to clamp one end of the ulcer bottom 10A, the operating wire (not shown) is operated with the hand operating unit that operates the operating tube portion 65 to close the outer clip 62, move the other end of the ulcer bottom 10A toward the one end, and suture the ulcer bottom 10A, as shown in Figure 17(c). After suturing the ulcer bottom 10A formed at the site where the lesion in the gastrointestinal mucosal layer was excised, the sheath 2 is retracted with the hand operating unit, and the clip 6 can be removed from the support member, as in Figures 8 and 9 of the first embodiment.

[0079] The clip 6 and medical catheter 1A of this embodiment described above provide the following advantages. The clip 6 is configured to include an inner clip 61 in which the distal ends of a pair of arms 611 are biased toward opening in an openable state, an outer clip 62 in which the distal ends of a pair of arms 612 are biased toward opening in an openable state, a first support part 63 that supports the inner clip 61, a second support part 64 that is cylindrically disposed outside the first support part 63 and configured to be movable relative to the inner clip 61 to draw the inner clip 61 into the cylindrical part and move the inner clip 61 toward closing, and an operating cylinder part 65 that is cylindrically disposed outside the second support part 64 and configured to be movable relative to the outer clip 62 to draw the outer clip 62 into the cylindrical part and move the outer clip 62 toward closing. Thus, by closing the inner clip 61 to clamp one end of the ulcer bottom 10A, and then closing the outer clip 62 to bring the other end of the ulcer bottom 10A together, the excised portion of the mucosal layer that has been excised over a wide area can be easily sutured.

[0080] 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.

[0081] In the first embodiment, two through openings, a first through opening 331 and a second through opening 332, are provided in the clip holding portion 33 (holding portion), and the base-end portion of the first clip 31 is disposed to pass through the first through opening 331, and the base-end portion of the second clip 32 is disposed to pass through the second through opening 332. However, this is not limited to this. One through opening may be provided in the holding portion, and both the base-end portion of the first clip 31 and the base-end portion of the second clip 32 may be disposed to pass through the one through opening.

[0082] In the second embodiment, the cylindrical second support portion 64 is moved relative to the inner clip 61 (third clip), thereby moving the inner clip 61 (third clip) to the closing side or the opening side, but this is not limited thereto. Any configuration is possible as long as the second support portion 64 is moved relative to the inner clip 61, and the inner clip 61 (third clip) may be moved relative to the cylindrical second support portion 64. Similarly, in the second embodiment, the inner clip 61 (third clip) is moved to the closing side or the opening side by moving the operation tube portion 65 relative to the outer clip 62 (fourth clip), but this is not limited thereto. Any configuration is possible as long as the operation tube portion 65 is moved relative to the outer clip 62 (fourth clip), and the outer clip 62 (fourth clip) may be moved relative to the operation tube portion 65.

[0083] In the above-described embodiment, the clips 31, 61 and clips 32, 62 constituting the clips 3, 6 are formed of a metal material, but this is not limiting. All of the components constituting the clips 3, 6 may be formed of a metal material or a biodegradable material. If all of the components constituting the clips 3, 6 are formed of a biodegradable material, the biodegradable material will decompose over time in the body, eliminating the need to remove the clips from the body. [Explanation of symbols]

[0084] 1,1A Medical Catheter 2 sheath 3,6 Clips (medical clips) 4 Support member 31 1st Clip 32 2nd Clip 33 Clip holding part (holding part) 41 Gripping part 51 First operating wire (operating member) 52 Second operating wire (operating member) 61 Inner clip (third clip) 62 Outer clip (4th clip) 63 1st support part 64 Second support part 65 Operation barrel 311 Arm part (first claw part) 321 Arm part (second claw part) 611 Arm part (third claw part) 612 Arm part (fourth claw part) 331 First through opening (through opening) 332 First through opening (through opening)

Claims

1. a first clip having a pair of first claws connected at their base ends, the tip ends of the pair of first claws being biased toward an opening side in an openable / closable state; a second clip arranged in parallel with the first clip, having a pair of second claws connected at their base ends, and biased toward an opening side such that the tip ends of the pair of second claws are openable and closable; a holding portion having a through opening through which a base end portion of the first clip and a base end portion of the second clip are passed, and which holds the first clip and the second clip in an openable and closable manner.

2. 2. The medical clip according to claim 1, wherein the retaining portion is configured so that by passing a base-end portion of the first clip and a base-end portion of the second clip through the through opening and moving them rearward, the pair of first claw portions or the pair of second claw portions can be moved toward each other and closed against the biasing force by the through opening.

3. a third clip having a pair of third claws whose base ends are connected to each other, and whose tip ends are biased toward an opening side in an openable and closable state; a fourth clip having a pair of fourth claws whose base ends are connected to each other, and whose tip ends are biased toward an opening side in an openable and closable state; a first support portion connected to a base end side of the third clip and supporting the third clip; a second support part formed in a cylindrical shape and arranged outside the first support part, configured to be movable relative to the third clip so that the third clip is drawn into the cylindrical part and moved to the closing side, the second support part being connected to a base end side of the fourth clip and supporting the fourth clip; a cylindrical operating tube portion that is arranged outside the second support portion and is configured to be able to move relative to the fourth clip, thereby drawing the fourth clip into the interior of the cylindrical portion and moving the fourth clip toward the closing side.

4. a tubular sheath that is inserted into the body; The medical clip according to claim 1 or 2, which is provided at the distal end of the sheath; a long support member that is passed through the inside of the sheath and has a tip connected to the medical clip; an elongated operating member that is passed through the inside of the sheath along the support member, has a distal end connected to the medical clip, and is operated to move a proximal end portion of the first clip and a proximal end portion of the second clip; 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.

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