Cartridge and Clip Cartridge System

Abstract

To provide a cartridge enabling a clip to be easily stored in a sheath and a clip cartridge system comprising the cartridge.SOLUTION: A cartridge 200 is to be used for coupling a clip 110 to a long processing tool body and comprises a storage part for storing the clip 110. On the cartridge 200 is formed an insertion part (insertion hole 43) which communicates with the storage part and into which a sheath is to be inserted. The insertion hole 43 is constructed to be elastically deformable so as to narrow its lumen; a protrusion 46 is formed on a wall surface 418c defining the insertion hole 43. The protrusion 46 protrudes so as to be close to the sheath inserted in the insertion hole 43 and is formed so as to permit forward and backward movement of an operation wire 20 while restricting movement of the sheath in a state in which the insertion part (insertion hole 43) is elastically deformed by application of external force.SELECTED DRAWING: Figure 5

Description

[Technical field]

[0001] The present invention relates to a cartridge and a clip cartridge system. [Background technology]

[0002] There is provided an endoscopic clipping device that excises biological tissue in a body cavity under an endoscope and ligates the excised area to stop bleeding. Regarding this type of endoscopic clipping device, Patent Document 1 describes that the arrowhead hook at the tip of the operating wire provided on the treatment tool body is inserted into and connected to a connecting member (described as a pressing tube in the document) at the base end of the clip, thereby connecting the clip to the treatment tool body. The document also describes how the operating wire, clip and connecting member are housed in a sheath (described in the document as an introduction tube) and passed through a channel of the endoscope to approach the target site.

[0003] In order to ligate biological tissue using the endoscopic clipping device of Patent Document 1, the operating wire is pulled with the arrowhead hook inserted into the connecting member. When the operating wire is further pulled strongly after the biological tissue is ligated, the thin-diameter portion of the connecting member breaks, and the clip is placed in the body cavity with the biological tissue ligated. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] JP 2004-121485 A Summary of the Invention [Problem to be solved by the invention]

[0005] As described above, in the endoscopic clip device of Patent Document 1, multiple members, such as the operating wire, clip, and connecting member, must be housed inside the sheath, and the housing work is time-consuming. In particular, even if the clip is held in a closed state by the connecting member, it may open due to its elastic restoring force when an external force is applied, and it is not easy to house it inside the sheath.

[0006] The present invention has been made in consideration of the above-mentioned problems, and provides a cartridge that can easily house a clip in a sheath, and a clip cartridge system including the cartridge. [Means for solving the problem]

[0007] The cartridge according to the present invention is used for connecting a clip to a long treatment instrument main body including a sheath formed to be long and capable of accommodating a clip, and an operation wire inserted inside the sheath so as to be movable forward and backward in the axial direction of the sheath and having a clip connecting portion at its distal end which is connected to the clip, and is equipped with a housing portion for accommodating the clip, and an insertion portion is formed which communicates with the housing portion and extends long and into which the sheath is inserted, the insertion portion is configured to be elastically deformable so as to narrow its inner cavity, and a protrusion is formed on a wall surface defining the insertion portion, and the protrusion protrudes so as to approach the sheath inserted in the insertion portion, and when an external force is applied and the insertion portion is elastically deformed, the protrusion controls the movement of the sheath. the cartridge is formed to allow the operation wire to move back and forth while limiting the insertion portion's movement, the cartridge comprises two plate-like case pieces assembled in a thickness direction, the two case pieces each comprising a thick portion, a thin portion formed continuously with the thick portion to define at least a part of the insertion portion, and a step portion provided at the boundary between the thick portion and the thin portion, the thick portion and the thin portion are overlapped so that they face each other, a plurality of the protrusions are provided along the extension direction of the insertion portion, both ends of the step portion extend in a direction perpendicular to the extension direction of the insertion portion, and a central portion of the step portion in a direction perpendicular to the extension direction of the insertion portion and perpendicular to the thickness direction of the cartridge becomes smaller as it approaches the insertion portion from the both ends. The storage section side and at least one of the plurality of protrusions is provided at a position overlapping with a region connecting both ends of the step portion when viewed in the thickness direction of the cartridge. A clip cartridge system according to the present invention is characterized by comprising the cartridge, the treatment tool body, and a clip accommodated in the accommodation portion. Effect of the Invention

[0008] According to the cartridge of the present invention, the protrusion is formed on the wall surface that defines the insertion portion, so that the clip can be housed within the sheath while the movement of the sheath is suitably restricted. [Brief description of the drawings]

[0009] [Figure 1] FIG. 2 is an exploded perspective view of the cartridge according to the embodiment. [Diagram 2] FIG. [Diagram 3] 4 is a perspective view of inner case components that form the inner case of the cartridge. FIG. [Figure 4] FIG. 2 is a plan view of the clip in an open position. [Diagram 5] FIG. 4 is a plan view showing a state in which a clip is housed in the cartridge. [Figure 6] FIG. 6 is a side cross-sectional view taken along line AA in FIG. 5. [Figure 7] 1 is a perspective view showing an example of an endoscopic clip device. [Figure 8] 10A to 10C are schematic diagrams for explaining a series of operations for attaching a clip to a treatment tool body of an endoscopic clip device. [Figure 9] 10A to 10C are schematic diagrams for explaining a series of operations for attaching a clip to a treatment tool body of an endoscopic clip device. [Figure 10] 10A to 10C are schematic diagrams for explaining a series of operations for attaching a clip to a treatment tool body of an endoscopic clip device. [Figure 11] 10A to 10C are schematic diagrams for explaining a series of operations for attaching a clip to a treatment tool body of an endoscopic clip device. [Figure 12] 1A and 1B are diagrams showing a clip in a closed arm state, in which (a) is a plan view and (b) is a side view. [Figure 13] FIG. 11 is a plan view of a cartridge according to a modified example. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] Hereinafter, an embodiment of the present invention will be described with reference to the drawings. In all the drawings, the same components are denoted by the same reference numerals, and duplicated descriptions will be omitted as appropriate.

[0011] Fig. 1 is an exploded perspective view of a cartridge 200 according to an embodiment, and Fig. 2 is a side view of the cartridge 200. Fig. 3 is a perspective view of an inner case component 31 that constitutes an inner case 30 (see Fig. 1) of the cartridge 200. Fig. 4 is a plan view of a clip 110 in an open arm state. FIG. 5 is a plan view showing a state in which clips 110 are housed in cartridge 200. As shown in FIG. 5, of the pair of outer case components 41 constituting the outer case 40, the upper outer case component 41 is omitted from illustration. Furthermore, in FIG. 5, of the pair of inner case components 31 constituting the inner case 30, only a side wall 315 (described later) and an adjacent wall 316 (described later) of the upper inner case component 31 are shown. FIG. 6 is a side cross-sectional view taken along the line AA in FIG. 5, and FIG. 7 is a perspective view showing an example of an endoscopic clipping device (hereinafter sometimes abbreviated to clipping device) 100. As shown in FIG. 8 to 11 are schematic diagrams for explaining a series of operations for attaching the clip 110 to the treatment tool body 90 of the endoscopic clip device 100. FIG. Fig. 12 shows the clip 110 in a closed arm state, where (a) is a plan view and (b) is a side view. Fig. 13 is a plan view showing a cartridge 201 according to a modified example.

[0012] In this specification, unless otherwise specified, the term "axial direction" refers to the advancement / retraction direction of the operating wire 20 (see FIG. 8, etc.) of the treatment tool body 90. In addition, unless otherwise specified, the term "cross section" refers to a longitudinal cross section of the endoscopic clip device 100 cut in the axial direction. Additionally, unless otherwise specified, the term "distal side (or distal)" refers to the side of the endoscopic clipping device 100, the clip 110 attached thereto, or the cartridge 200 that is farther from the operator of the endoscopic clipping device 100. Specifically, this refers to the side on which the tip (claw portion 126) of the arm portion 120 of the clip 110 is located. Additionally, unless otherwise specified, the term "proximal side (or proximal)" refers to the side of the endoscopic clipping device 100, the clip 110, or the cartridge 200 that is closer to the operator.

[0013] Furthermore, the movement of a component of the endoscopic clipping device 100, the clip 110, or the cartridge 200 toward the distal side may be referred to as advancing, and conversely, the movement toward the proximal side may be referred to as retreating (retracting). Additionally, "distal side (or distal)" is used synonymously with "distal side (or distal)" and "base side (or base end)" is used synonymously with "proximal side (or proximal)." Moreover, the direction from the base end side to the tip end side, or from the tip end side to the base end side, is referred to as the tip-to-base direction or the anterior-posterior direction. As will be described later, the cartridge 200 is formed flat. A direction perpendicular to both the tip-base end direction and the thickness direction (wall thickness direction) of the cartridge 200 is referred to as a width direction.

[0014] <Summary> First, the present invention will be outlined with reference mainly to FIGS. The cartridge 200 of this embodiment is used to connect the clip 110 to a long treatment instrument body 90, which includes a sheath 10 formed to be long and capable of accommodating a clip 110, and an operating wire 20 inserted inside the sheath 10 so as to be able to move back and forth in the axial direction of the sheath 10, and having a clip connecting portion 50 at its distal end which is connected to the clip 110, and has a storage portion (second storage area 42) that stores the clip 110, as shown in Figures 7 and 8, etc. The cartridge 200 is formed with an insertion portion (insertion hole 43) that communicates with the second housing area 42 and extends long, into which the sheath 10 is inserted. The insertion portion (insertion hole 43) is configured to be elastically deformable so as to narrow its inner cavity, and a protrusion 46 is formed on a wall surface 418c that defines the insertion hole 43. The protrusion 46 protrudes toward the sheath 10 inserted into the insertion hole 43, and is formed so as to restrict the movement of the sheath 10 while allowing the operating wire 20 to move back and forth when an external force is applied and the insertion portion (insertion hole 43) is elastically deformed.

[0015] According to the above configuration, a protrusion 46 is formed on the wall surface 418c that defines the insertion portion (insertion hole 43), and thus the cartridge 200 is elastically deformed to restrict the movement of the sheath 10 with the protrusion 46, and the operating wire 20 to which the clip 110 is connected is retracted, whereby the clip 110 can be accommodated within the sheath 10.

[0016] Moreover, the clip cartridge system 200S according to this embodiment is characterized by including a cartridge 200, a treatment tool main body 90, and a clip 110 accommodated in an accommodating portion (second accommodating region 42). According to the above configuration, the effects of the cartridge 200 can be obtained in the clip cartridge system 200S as well.

[0017] <Configuration> Next, the configuration of each part of the cartridge 200 and the clip cartridge system 200S according to this embodiment will be described in detail.

[0018] [cartridge] As described above, the cartridge 200 is used to connect the clip 110 to the long treatment tool body 90. As shown in any one of FIGS. 1, 5, 6, and 8 to 11, the cartridge 200 includes an inner case 30 and an outer case 40. The inner case 30 and the outer case 40 are made of a plastic material.

[0019] Of these, the inner case 30 has a first housing area 32 for housing the clip 110 therein. 6, the inner case 30 is formed by assembling a pair of inner case components 31. The inner case 30 has a flat rectangular shape in a plan view, and has a first housing area 32 therein for housing the clip 110. More specifically, the pair of inner case components 31 are formed to have the same shape as each other.

[0020] [Inner case components] As shown in Figs. 1 and 3, the inner case component 31 has a flat plate-like portion 311 that is rectangular in plan view. The pair of inner case components 31 are assembled to each other such that one surface of the plate-like portions 311 faces each other, thereby forming the inner case 30 .

[0021] The inner case component 31 further has a side wall 315 that is provided at one side end in the width direction of the plate-like portion 311 and stands up from one surface of the plate-like portion 311. The side wall 315 extends in the front-rear direction. The inner case 30 is accommodated in the second accommodating area 42 with one side wall 315 positioned at one end in the width direction of the second accommodating area 42, and the other side wall 315 positioned at the other end in the width direction of the second accommodating area 42 (see Figure 5).

[0022] The plate-shaped portion 311 has a protrusion 312 formed at a front end on one surface of the plate-shaped portion 311, and a hole 313 formed at the front end. The hole 313 opens on at least one surface of the plate-shaped portion 311. In the present embodiment, the hole 313 penetrates the plate-shaped portion 311 from the front to the back, and therefore opens on both surfaces of the plate-shaped portion 311. The protrusions 312 and the holes 313 are arranged symmetrically to each other in the width direction. More specifically, of the protrusions 312 and the holes 313, the holes 313 are arranged in the vicinity of the side wall 315, and the protrusions 312 are arranged on the side farther from the side wall 315. When a pair of inner case components 31 are assembled together, the protrusion 312 of one inner case component 31 fits into the hole 313 of the other inner case component 31, and the protrusion 312 of the other inner case component 31 fits into the hole 313 of one inner case component 31.

[0023] Furthermore, a recess 314 for accommodating the arm 120 of the clip 110 is formed on one surface of the plate-like portion 311. The recess 314 is formed symmetrically in the width direction. When the pair of inner case components 31 are assembled, the opposing distance between the pair of recesses 314 defines a part of the first housing area 32, that is, a portion that houses the arm portion 120.

[0024] On one surface of plate-shaped portion 311, at a position adjacent to the base end side of recess 314, a ring retaining recess 317 for retaining fastening ring 150 of clip 110 in a fitted state is formed. 3, ring-retaining recess 317 is formed in a half-cylinder shape (for example, a half-cylinder shape) and is recessed below the bottom surface of recess 314. Ring-retaining recess 317 is disposed on the base end side of the center of recess 314 in the width direction.

[0025] 3, one surface of the plate-like portion 311 is further formed with an inclined surface 318 adjacent to the base end side of the ring holding recess 317. The inclined surface 318 is inclined so as to become higher toward the base end side. The lower end of the inclined surface 318 intersects with the rear end of the ring holding recess 317 , and the inclined surface 318 extends to a position higher than the bottom surface of the recess 314 .

[0026] Furthermore, on one surface of plate-like portion 311, locking portion accommodating recess 319 is formed adjacent to the base end side of inclined surface 318. Locking portion accommodating recess 319 is formed in a half-split cylindrical shape (for example, a half-split square cylindrical shape) and is located at a position higher than the bottom surface of recess 314.

[0027] Furthermore, on one surface of the plate-shaped portion 311, an adjacent wall 316 is formed at a position adjacent to one side in the width direction of the ring retaining recess 317, the inclined surface 318, and the locking portion accommodating recess 319, which stands (protrudes) in the same direction as the side wall 315. The adjacent wall 316 stands at the same height as the side wall 315. The rear end surface of the adjacent wall 316 is disposed at the rear end position of the inner case component 31.

[0028] The rear end surface of the adjacent wall 316 and the like constitute an advancement restricting portion 322 that selectively restricts the advancement of the reduced diameter sleeve 70 between the reduced diameter sleeve 70 and the clip connecting portion 50. That is, the inner case 30 has the advancement restricting portion 322.

[0029] Furthermore, a pair of slits 320 extending in the tip-to-base direction are formed in the plate-like portion 311. One of the slits 320 is disposed on one side in the width direction relative to the ring retaining recess 317, the inclined surface 318, the locking portion accommodating recess 319, and the adjacent wall 316. The other of the slits 320 is disposed on the other side in the width direction relative to the ring retaining recess 317, the inclined surface 318, the locking portion accommodating recess 319, and the adjacent wall 316. The front ends of the pair of slits 320 are located, for example, near the front end of the recess 314, and the rear ends of the slits 320 reach the rear end of the inner case component 31. Thus, the pair of slits 320 are open toward the rear.

[0030] Since such a pair of slits 320 are formed in the plate-shaped portion 311, the portion of the plate-shaped portion 311 sandwiched between the pair of slits 320 constitutes a movable piece 321 that can be displaced in the thickness direction of the plate-shaped portion 311 as the plate-shaped portion 311 elastically deforms. The movable piece 321 includes the ring retaining recess 317 , the inclined surface 318 , the locking portion accommodating recess 319 and the adjacent wall 316 .

[0031] When the pair of inner case components 31 are assembled together, the adjacent wall 316 overlaps in the thickness direction with the mating plate-like portion 311. For this reason, the movable piece 321 is formed with a notched portion 323 for avoiding interference with the tip end of the mating adjacent wall 316.

[0032] The pair of inner case components 31 are assembled to each other so that the clip 110 is accommodated in the first accommodating area 32 formed between them to form the inner case 30 (see Figures 6, 8(a), etc.).

[0033] Here, the protrusions 312 and the holes 313 of the pair of inner case components 31 fit together. That is, the inner case 30 is formed by combining a pair of inner case components 31 formed to have the same shape, and the pair of inner case components 31 fit together while facing each other.

[0034] In addition, the dimension of the inner case 30 in the width direction is set to be slightly smaller than the inner dimension of the second accommodating area 42, and the inner case 30 is movable back and forth within the second accommodating area 42. More specifically, the outer surfaces of the pair of side walls 315 are guided by the inner surfaces of the side walls 422 of the outer case component 41, and the inner case 30 slides back and forth relative to the outer case 40.

[0035] [Outer case components] As shown in FIG. 1, (the outer case 40) of the cartridge 200 includes two plate-shaped case pieces (outer case components 41) that are assembled in the thickness direction. The pair of outer case components 41 each have a plate-like portion 411 formed in a flat plate shape that is elongated in the front-rear direction and has a rectangular shape in a plan view. The outer case 40 also has a long insertion hole 43 through which the treatment tool main body 90 is inserted, and a second accommodating area 42 (see Figure 8) that communicates with the tip of the insertion hole 43 and accommodates the inner case 30 so that it can be moved toward the tip end and the base end. The outer case 40 is also formed by assembling a pair of outer case components 41. The outer case 40 has a flat rectangular shape in a plan view that is elongated in the front-rear direction, and has a second housing area 42 therein that houses the inner case 30. More specifically, the pair of outer case components 41 are formed to have the same shape. The insertion hole 43 is not limited to one having a circular cross section, but includes one having a partially open portion defined by a pair of groove bodies 418a formed in an arc-shaped cross section according to this embodiment.

[0036] A recess 424 (see FIG. 1) for accommodating the inner case 30 is formed in the front part of one surface of the plate-like portion 411. When the pair of outer case components 41 are assembled, the opposing distance between the pair of recesses 424 defines a second accommodating area 42. The outer case 40 has a tip wall 421 disposed adjacent to the front side of the recess 424, and a pair of side walls 422 disposed adjacent to both sides of the recess 424 in the width direction. The tip wall 421 extends in the width direction, while the pair of side walls 422 each extend in the front-rear direction. The tip wall 421 and the side walls 422 each stand upright from one surface of the plate-like portion 411 .

[0037] When the pair of outer case components 41 are assembled, the top surfaces of the tip walls 421 come into contact with each other. A protrusion 416 is formed on the top surface of the tip wall 421, protruding toward the opposing tip wall 421. A notch 417 is formed on the back surface side of the tip wall 421, into which the opposing protrusion 416 fits when the pair of outer case components 41 are assembled. The protrusion 416 and the notch 417 are disposed symmetrically to each other in the width direction.

[0038] A protrusion 414 and a hole 415 are formed at the rear end of the plate-like portion 411. The protrusion 414 and the hole 415 are disposed symmetrically to each other in the width direction. The protrusion 414 is formed so as to protrude further from a protruding portion 423 that protrudes from one surface of the plate-like portion 411 . The hole 415 penetrates the raised portion 423 and the plate-like portion 411 from front to back, and is formed in a shape that allows the protrusion 414 to be fitted therein. When the pair of outer case components 41 are assembled together, the protrusions 414 are fitted into the holes 415 up to their bases, and the opposing surfaces (top surfaces) of the protruding portions 423 come into contact with each other.

[0039] On the rear side of the recess 424, the protrusion 412, the hole 429, the surrounding wall 425, the locking claw 428, the guide protrusion 413 and the hole 427 are provided in a horizontal arrangement.

[0040] Of the protrusion 412, hole 429, surrounding wall 425, locking claw 428, guide protrusion 413, and hole 427, the protrusion 412 is disposed at one end in the width direction and protrudes from one surface of the plate-shaped portion 411 higher than the top surface of the side wall 422. The hole 427 penetrates the plate-shaped portion 411. The protrusion 412 and hole 427 are disposed symmetrically to each other in the width direction.

[0041] The guide protrusion 413 is disposed at a position adjacent to the hole portion 427 in the width direction, and protrudes in the same direction as the protrusion portion 412 from one surface of the plate-shaped portion 411. The guide protrusion 413 guides the protrusion portion 412 toward the hole portion 427 when the pair of outer case components 41 are assembled to each other.

[0042] The locking claw 428 is disposed closer to the center in the width direction than the guide protrusion 413, protrudes from one surface of the plate-shaped portion 411 in the same direction as the protrusion portion 412, and has a bent tip in a claw shape.

[0043] The hole 429 penetrates the plate-like portion 411. The hole 429 and the locking claw 428 are disposed symmetrically to each other in the width direction. When the pair of outer case components 41 are assembled together, the locking claws 428 are fitted into the holes 429 and locked.

[0044] The surrounding wall 425 is disposed in the center in the width direction, and surrounds the opening at the tip of the insertion hole 43. The surrounding wall 425 is formed higher than the recess 424. The front surface of the surrounding wall 425 is formed flat and faces forward. When the pair of outer case components 41 are assembled together, the protrusions 412 are adapted to fit into the holes 427. The protrusions 412 and the holes 427 are also referred to as fitting portions 433.

[0045] In addition, the pair of outer case components 41 have the protrusion 416 and the cutout portion 417 fitted together, the protrusion 414 and the hole portion 415 fitted together, the protrusion 412 and the hole portion 427 fitted together, and the locking claw 428 and the hole portion 429 fitted together. That is, the outer case 40 is configured by combining a pair of outer case components 41 formed to have the same shape, and the pair of outer case components 41 are fitted together while facing each other.

[0046] The two outer case component parts 41 each include a thick portion 430, a thin portion 431 formed continuously with the thick portion 430 and defining at least a portion of the insertion portion (insertion hole 43), a step portion 432 provided at the boundary between the thick portion 430 and the thin portion 431, and a fitting portion 433 that fits into the other outer case component part 41. The thick portion 430 and the thin portion 431 are overlapped so as to face each other. The fitting portions 433 are provided side by side, at least one on each side of the insertion hole 43, in a direction intersecting the direction in which the insertion hole 43 extends. At least a part of the step portion 432 extends parallel to the arrangement direction of the fitting portions 433 . The fitting portions 433 refer to both the protrusions 412 provided on the pair of outer case components 41 and the holes 427 into which the protrusions 412 fit.

[0047] According to the above configuration, when the fitting portions 433 of the two case pieces (outer case components 41) are assembled, the load is unlikely to be dispersed in a direction deviating from the assembly direction (thickness direction) because the step portion 432 extends parallel to the arrangement direction of the fitting portions 433. This makes it easier to simultaneously fit the fitting portions 433 on both sides of the insertion hole 43, and the outer case components 41 can be easily assembled together.

[0048] The step portion 432 according to this embodiment is composed of an outer step portion 432X on the outer surface side and an inner step portion 432Y. By forming the outer step portion 432X, it is possible to suppress protrusion in the thickness direction of the thin portion 431 and an external protrusion 431a (described later) protruding vertically from the thin portion 431. Furthermore, by forming the inner stepped portion 432Y, it is possible to form a large opening 45 through which gas passes during sterilization, which will be described later. For example, the step portion 432 may be composed of only the inner step portion 432Y. Also, the outer step portion 432X and the inner step portion 432Y are formed at an incline with respect to the front surface of the cartridge 200, but may be formed at a right angle.

[0049] As shown in FIG. 5, end 432a of step portion 432 located on the central side of thin portion 431 in the extending direction of insertion portion (insertion hole 43) extends in a direction perpendicular to the extending direction of insertion portion (insertion hole 43). When the user pinches the thin-walled portions 431 of the two outer case components 41 so that they approach each other, the thin-walled portions 431 begin to bend from the ends of the thin-walled portions 431 (i.e., the step portions 432 at the boundary with the thick-walled portions 430) in a direction intersecting their longitudinal direction (the same direction as the extension direction of the insertion holes 43). As described above, the central end 432a of the thin-walled portion 431 at the step portion 432 extends in a direction perpendicular to the extension direction of the insertion portion (insertion hole 43), thereby allowing the thin-walled portion 431 to bend suitably in the longitudinal direction. On the other hand, if the end 432a of the step portion 432 extends in a direction that intersects obliquely with the extension direction of the insertion hole 43 rather than in a direction perpendicular to the extension direction of the insertion hole 43, when a load is applied in a direction that causes the thin-walled portion 431 to bend, a force (component force) having a directional component that intersects the longitudinal direction of the thin-walled portion 431 is generated on the step portion 432, making it difficult for the thin-walled portion 431 to bend.

[0050] As shown in FIG. 2, openings 45 are formed on both side surfaces (side walls 422) of the cartridge 200 in a direction perpendicular to the thickness direction. The opening 45 is located between the thin-walled portions 431 of the two case pieces (the outer case components 41), and is partially defined by a step portion 432. At least both end portions 432a of the step portion 432 extend in a direction perpendicular to both side surfaces. According to the above configuration, both end portions 432a of the step portion 432 extend in a direction perpendicular to both side surfaces (side walls 422) of the cartridge 200, thereby improving the flowability of gas flowing through the openings 45 in both side walls 422 of the cartridge 200 during gas sterilization. In other words, at both ends 432a, the flow path area of ​​the gas passing through opening 45 does not expand or contract, so the gas can pass through evenly, and gas sterilization via opening 45 can be carried out appropriately.

[0051] As shown in FIG. 5, a plurality of protrusions 46 formed on a wall surface 418c that defines the insertion hole 43 are provided along the extending direction of the insertion portion (insertion hole 43). The central portion 432b of the step portion 432 in a direction perpendicular to the extension direction of the insertion hole 43 and perpendicular to the thickness direction of the cartridge 200 (also referred to as the "width direction" in this document) is inclined toward the outside in the extension direction of the insertion hole 43 as it approaches the insertion hole 43 from both end portions 432a. At least one of the multiple protrusions 46 (protrusion 46a) is provided at a position overlapping a region connecting both end portions 432a of the step portion 432 when viewed in the thickness direction of the cartridge 200.

[0052] In this way, at least one of the protrusions 46 (protrusion 46a) is located in the region connecting both end portions 432a of the step portion 432 and is spaced away from the central portion 432b in the width direction of the step portion 432, so that the protrusion 46a can approach the sheath 10 when the thin-walled portion 431 is bent. In other words, the protrusion 46a is contained within the range in which the thin-walled portion 431 bends, and can function to hold the sheath 10 when the thin-walled portion 431 is pressed and bent by the user.

[0053] Incidentally, the step portion 432 according to this embodiment is formed to be inclined obliquely so that the thickness gradually increases from the thin portion 431 to the thick portion 430 in the longitudinal direction. Moreover, the "end 432a" of the step portion 432 refers to the inclined end surface, and the "region connecting both end portions 432a" refers to a band-shaped region including the inclined end surface.

[0054] The cartridge 200 has a contact portion (middle protrusion portion 426) on the other of the two outer case components 41 that abuts against one of the two case pieces (outer case components 41) when the thin-walled portion 431 is bent, limiting the bending of the thin-walled portion 431. The intermediate protrusions 426 are provided on both sides of at least one of the multiple protrusions 46 (protrusion 46c) in a direction perpendicular to the direction in which the insertion portion (insertion hole 43) extends.

[0055] In the outer case component 41, the area between the area where the protrusion 412, hole 429, surrounding wall 425, locking claw 428, guide protrusion 413 and hole 427 are arranged and the area where the pair of raised portions 423 at the rear end are arranged is formed at a lower level than the raised portions 423. The intermediate protrusion 426 is formed at a central position in the front-rear direction of this low-stage portion. The height position of the top surface of the intermediate protrusion 426 is slightly lower than the height position of the top surface of the raised portion 423. When the pair of outer case components 41 are assembled to each other, the top surfaces of the pair of intermediate protrusions 426 are spaced apart by a slight amount, and are configured to allow the thin-walled portion 431 to flex by a predetermined amount. In addition, in the plate-like portion 411, for example, one intermediate protrusion portion 426 is formed on each side of an insertion hole forming groove 418 described later.

[0056] In addition, in the pair of outer case constituent parts 41 according to this embodiment, a pair of intermediate protrusions 426 is formed on each of the outer case constituent parts 41 . When a pair of outer case components 41 are stacked to form the outer case 40, a pair of intermediate protrusions 426 are arranged in opposing positions, but the present invention is not limited to this configuration as long as the amount of deflection of the thin-walled portion 431 can be limited to a small amount. For example, only one intermediate protrusion 426 may be provided on each of a pair of outer case components 41. In this case, the intermediate protrusion 426 may abut against the thin-walled portion 431 of the overlapping outer case components 41 to limit the amount of deflection to a small amount.

[0057] Since the abutment portions (middle protrusions 426) are provided on both sides of the protrusion 46c in a direction perpendicular to the insertion portion (insertion hole 43), when the thin-walled portion 431 is bent, the bending of the thin-walled portion 431 is restricted by the middle protrusions 426. This prevents the load on the sheath 10 from being biased toward one protrusion 46c located between the middle protrusions 426, making it easier to press the sheath 10 with the multiple protrusions 46.

[0058] An external protrusion 431a that protrudes outward in the thickness direction of the cartridge 200 is provided at the center of the thin portion 431 according to this embodiment. The external protrusion 431a is disposed so as to surround at least a portion of the protrusions 46b, 46c when viewed in the thickness direction of the cartridge 200. Incidentally, instead of the external protrusion 431a, or together with the external protrusion 431a, a recess (not shown) recessed inward in the thickness direction of the cartridge 200 may be formed.

[0059] According to the above configuration, when the clip 110 is inserted into the sheath 10, the user can tactilely feel the position of the protrusions 46b, 46c or a depression (not shown) in the center of the thin-walled portion 431, which serves as a pressing position for maintaining the position of the sheath 10.

[0060] In this embodiment, an external protrusion 431a that protrudes outward in the thickness direction of the cartridge 200 is provided in the central portion of the thin portion 431. At least one of the multiple protrusions 46 (protrusions 46b, 46e) is formed at a position overlapping a region where the external protrusion 431a is formed when viewed in the thickness direction of the cartridge 200. It should be noted that, when the external protrusions 431a are formed intermittently as in this embodiment, the "region in which the external protrusions 431a are formed" includes the region between adjacent external protrusions 431a. In addition, "the position overlapping the area where external protrusion 431a is formed" is, more specifically, the position overlapping the area where external protrusion 431a is formed when viewed from a direction perpendicular to the main plane portion (plane portion having a larger area than the side portion) of thin-walled portion 431 (i.e., in a planar view).

[0061] According to the above configuration, when a user touches the external protrusion 431a and presses the thin-walled portion 431, the portion where the protrusions 46b, 46e overlap the external protrusion 431a is located is significantly bent, and the sheath 10 can be suitably pressed by the protrusions 46b, 46e.

[0062] The insertion end side (left side in FIG. 5) of the sheath 10 of the protrusion 46 extends in a direction perpendicular to the extending direction of the insertion portion (insertion hole 43). Moreover, the retraction side (right side in FIG. 5), which is the opposite side of the insertion end side of the protrusion 46, is tapered so that its width narrows toward the retraction end.

[0063] Because the protrusion 46 is configured in this manner, it is possible to reduce the frictional force generated when the sheath 10 is inserted into the insertion portion (insertion hole 43), making it easier for the user to insert the sheath 10 into the insertion hole 43. In addition, when the operating wire 20 to which the clip 110 is attached is retracted from the housing portion (second housing area 42), the protrusion 46 can effectively apply a frictional force in the opposite direction to the retraction direction to the sheath 10 attempting to retract.

[0064] In particular, the protrusion 46 is formed so that the amount of protrusion increases toward the insertion destination of the sheath. With this configuration, the sheath 10 can be smoothly inserted into the insertion portion (insertion hole 43) with reduced resistance, and when the operating wire 20 is retracted relative to the sheath 10, the sheath 10 can be prevented from moving in the retracting direction.

[0065] The thin-walled portion 431 is formed so as to bend when a load of 1 N or more and 15 N or less is applied thereto, thereby restricting the movement of the sheath 10 while allowing the movement of the operation wire 20 back and forth. By bending the thin-walled portion 431 within the above numerical range, the operation wire 20 can be easily pulled out while the sheath 10 is being held down.

[0066] The thin portion 431 according to this embodiment is configured to bend when a load of 12 N or more is applied, thereby restricting the movement of the sheath 10. The thickness of the thin-walled portion 431 according to this embodiment is 1.2 mm, and the area of ​​the thin-walled portion 431 as viewed from the front (as viewed in the thickness direction) is approximately 500 mm. 2 It is. The surface area of ​​one outer case component 41 is approximately 3070 mm 2 It weighs approximately 2g.

[0067] At the center in the width direction of the rear end of the plate-like portion 411, a notch 420 having a V-shape in plan view that widens toward the rear is formed. A linear insertion hole forming groove 418 is formed in the center in the width direction of one surface of the plate-like portion 411 , extending from the front end of the cutout portion 420 to the front end of the surrounding wall 425 . The through-hole forming groove 418 extends in the axial direction. The through-hole forming groove 418 is formed in a semi-cylinder shape, and when the pair of outer case components 41 are assembled to each other, the pair of through-hole forming grooves 418 are arranged opposite each other and joined together to form a cylindrical through-hole 43 (see FIG. 6, FIG. 8(a), etc.). Note that, although the straight through-hole 43 is illustrated in this embodiment, the through-hole 43 may be curved.

[0068] The through-hole forming groove 418 includes a groove body 418a which occupies most of the longitudinal portion of the through-hole forming groove 418, and a wide portion 418b which is located in front of the groove body 418a and is formed wider in the width direction than the groove body 418a. The inner diameter of the groove body 418a (i.e., the inner diameter of the insertion hole 43) is set to be slightly larger than the outer diameter of the sheath 10, and when the sheath 10 is inserted into the insertion hole 43, the sheath 10 is guided forward along the peripheral wall of the insertion hole 43. At the front end of the insertion hole forming groove 418, a stopper forming portion 419 that constitutes the stopper portion 44 (see FIGS. 6, 8(a), etc.) that restricts the forward movement of the sheath 10 is formed. The inner case component 31 and the outer case component 41 of the cartridge 200 are each configured as described above.

[0069] [clip] 4, clip 110 is for ligating biological tissue, and can perform treatments such as hemostasis, suturing, and marking by ligating biological tissue with arms 120. Clip 110 includes a clip body 110a having a plurality of arms 120 for gripping biological tissue and a locking portion 130 provided on the base end side of arms 120.

[0070] The arms 120 have a self-opening force, and as described below, when the arms 120 in a closed state are caused to protrude from the sheath 10, the arms 120 naturally open to an open state. Here, "self-opening" refers to the tendency of the arms 120 to open by themselves in reaction to an external force that tends to close them.

[0071] The clip 110 includes a clip body 110a having a plurality of arms 120 and a locking portion 130, as well as a fastening ring 150 into which the plurality of arms 120 are inserted together. The fastening ring 150 is configured to move toward the tip of the arm 120 relative to the arm 120, so that the tips (claw portions 126) of the plurality of arms 120 are closed to each other.

[0072] Further, the fastening ring 150 is held between the movable pieces 321 of the pair of inner case components 31. More specifically, the fastening ring 150 fits into a pair of ring holding recesses 317, and the rear end of the fastening ring 150 is restricted from moving rearward by a pair of inclined surfaces 318. In this embodiment, a pair of movable pieces 321 constitute a pair of ring clamping portions.

[0073] More specifically, the clip 110 includes a pair of arms 120 opposed to each other. Each of the pair of arms 120 includes a base end 122 that protrudes distally (to the left in FIG. 4) from the locking portion 130, and an arm body portion 124 that is connected to the distal side of the base end 122. The base end 122 is curved outward toward the distal side. Here, "outward" means a direction away from the axis of the manipulation wire 20 or an extension of the axis, for example, a radially outward direction. "Inward" means a direction toward the axis of the manipulation wire 20 or an extension of the axis, for example, a radially inward direction.

[0074] The arm main body parts 124 are formed in a straight line, and claw parts 126 are formed at the tips of the arm main body parts 124. The arm main body parts 124 and the claw parts 126 form a gripping region that mainly grips biological tissue. The claw parts 126 protrude inward from the pair of arm main body parts 124, and improve the gripping force of the clip 110 by biting into the biological tissue. Arm 120 is bent at the boundary between base end 122 and arm main body 124, and a narrow portion 123 is formed at this boundary where the width dimension of arm 120 is locally reduced (see FIG. 12(b)).

[0075] 4, the locking portion 130 and the pair of arms 120 are integrally molded to form the clip body 110a. That is, the claw portion 126, the arm body portion 124, and the base end portion 122 on one side and the claw portion 126, the arm body portion 124, and the base end portion 122 on the other side are seamlessly formed continuously via the locking portion 130. More specifically, the clip body 110a including the pair of arm portions 120 and the locking portion 130, which are integral with each other, can be produced by punching, pressing, and bending a metal plate material. Examples of such metal materials include, but are not limited to, stainless steel, titanium, and titanium alloys. The above-mentioned metal materials may also be those that have been subjected to a corrosion-resistant coating treatment.

[0076] A reinforcing section 125 is formed on arm main body section 124 by pressing (embossing) a portion of the center in the width direction (see FIG. 12(b)). By forming reinforcing section 125, the thickness dimension of arm main body section 124 is increased (see FIG. 4 and FIG. 12(a)), and the bending rigidity of arm main body section 124 is improved. This makes it possible to obtain a high gripping force on biological tissue. Reinforcing section 125 is formed continuously from the tip end of arm main body section 124 excluding claw section 126 to the base end leading to narrow section 123.

[0077] The fastening ring 150 of the clip 110 is attached so as to be movable forward and backward with respect to the arm portion 120. By moving the fastening ring 150 distally relative to the arm portion 120, the arm portion 120 in the open arm state (see FIG. 4) can be fastened by the fastening ring 150 against the self-opening force. This causes the arm portion 120 to be in a closed arm state (see each drawing of FIG. 12). Furthermore, by moving the fastening ring 150 backward relative to the arm portions 120, the arm portions 120 open by their own opening force. The annular fastening ring 150 may be a full annular ring whose entire circumferential surface is continuous in the circumferential direction, or may be a partial annular ring whose circumferential surface is provided with a notch or slit.

[0078] Arm body portion 124 of arm 120 is formed to be wider than base end portion 122 and narrow portion 123, and fastening ring 150 is restricted from climbing over narrow portion 123 and advancing to arm body portion 124. In addition, base end portion 122 is formed with wide portion 121 that is partially formed to be wider. The inner diameter of the proximal side of fastening ring 150 is smaller than the width dimension of wide portion 121. Therefore, fastening ring 150 is restricted from climbing over wide portion 121 and moving toward the proximal side of clip 110. The inner diameter of the distal side of fastening ring 150 is formed to be larger than the width dimension of wide portion 121. Note that the inner diameter of the distal side of fastening ring 150 is not limited to this configuration, and may be formed to be smaller than the width dimension of wide portion 121. The fastening ring 150 moves forward and backward relative to the arm portion 120 in a length region between the wide portion 121 and the arm main body portion 124. Then, the fastening ring 150 fits into the narrow portion 123, whereby the fastening ring 150 is engaged with the arm portion 120, and the clip 110 is locked in the closed arm state.

[0079] The locking portion 130 of the clip 110 has a receiving portion 134 having a space 132 therein for receiving the clip connecting portion 50 (FIG. 8(a) etc.) at the tip of the operating wire 20, and a protrusion 140 formed to protrude inward on the base end side of the receiving portion 134. The receiving portion 134 receives the clip connecting portion 50 in the space 132, whereby the clip 110 and the operating wire 20 are connected to each other.

[0080] The protrusions 140 are claws that are elastically deformed and released as they are pushed apart by the clip connecting parts 50, and then elastically restored to their original state to engage with and hold the clip connecting parts 50. The protrusion 140 is a portion disposed on the proximal side of the receiving portion 134 and closes a part or the whole of the space 132 in an openable manner. The shape, position, and size of the protrusion 140 are not particularly limited. For example, the receiving portion 134 may be formed in an annular shape, and the protrusion 140 may be formed to protrude radially inward from the circumferential surface of the annular receiving portion 134. Alternatively, as described below, the receiving portion 134 may be composed of a base portion 136 such as an annular shape and a protruding piece portion 142 protruding proximally from the base portion 136, and the protrusion 140 may be formed at the tip of the protruding piece portion 142.

[0081] The locking portion 130 includes a base portion 136 connected to the base end of the arm portion 120, and a plurality of protruding pieces 142 formed to protrude from the base portion 136 toward the base end side and constituting the receiving portion 134. The protrusions 140 are formed on the proximal tip portions of the protruding pieces 142, respectively.

[0082] The clip connecting portion 50 of the operating wire 20 is housed in a space 132 surrounded by the base 136, the protruding piece 142, and the protrusion 140. The inner diameter of the base 136 is smaller than the maximum outer diameter of the clip connecting portion 50, and the base 136 restricts the forward movement of the clip connecting portion 50. The protrusion 140 restricts the clip connecting portion 50 housed in the space 132 from moving backward. The clip connecting portion 50 housed in the space 132 may be restrained in the tip-proximal end direction by the base 136 and the protrusion 140, so that its forward and backward movement within the space 132 is restricted, or the clip connecting portion 50 may be able to move slightly forward and backward in the axial direction within the space 132.

[0083] Here, in the case of this embodiment, the clip connecting part 50 is a block. The clip connecting part 50 being "block-shaped" means that the clip connecting part 50 is thicker than the locking part 130, and when the clip connecting part 50 is connected to the locking part 130 and is removed from the locking part 130, the deformation of the clip connecting part 50 is sufficiently smaller than the deformation of the locking part 130. The specific shape of the block-shaped clip connecting part 50 is not particularly limited, and may be a shape in which the distal side part and the proximal end part are tapered toward the distal end and the proximal end, respectively, as shown in FIG. 8(a), or may be a columnar or spherical shape. For example, the cross-sectional shape of the clip connector 50 is a polygon, preferably a regular polygon cross-section. As an example, the clip connector 50 has a regular hexagon cross-section.

[0084] A plurality of protruding pieces 142 are arranged facing each other on the locking portion 130. The number of protruding pieces 142 is not limited, but it is preferable that the number is less than the number of outer circumferential flat surfaces of the clip connecting portion 50 having a polygonal cross section. Specifically, the locking portion 130 has, for example, two protruding pieces 142. The protruding pieces 142 are plate-shaped and have a width narrower than the diameter of the clip connecting portion 50. The two protruding pieces 142 are provided at positions that can face each other on the outer circumferential plane of the clip connecting part 50. More specifically, the two protruding pieces 142 are provided at positions that face each other 180 degrees on the base 136 of the locking part 130. However, the present invention is not limited to this example, and three protruding pieces 142 may be disposed facing each other at equal intervals of 120 degrees. The distance between the protruding pieces 142 is set to a dimension that allows each of the protruding pieces 142 to be in close contact with or in close proximity to the outer circumferential plane of the clip connecting part 50.

[0085] When the clip connecting part 50 is connected to the clip 110 (clip body 110a), the multiple protruding parts 142 are arranged in close contact with or adjacent to the clip connecting part 50 so as to surround the outer circumferential plane of the clip connecting part 50 received in the receiving part 134. As a result, when the clip connecting part 50 is rotated with torque, the outer circumferential plane of the clip connecting part 50 rotates the protruding parts 142 about the axis, and torque is applied to the entire clip body 110a via the locking part 130.

[0086] The protrusion 140 formed on the proximal tip of the protruding piece 142 is disposed on a circumference concentric with the base 136 and is formed in a partial arc shape. Each protrusion 140 forms a partial arc shape with a central angle of approximately 120 degrees, and is formed so that two protrusions 140 can hold an area of ​​approximately two-thirds of the circumference.

[0087] The base 136 is formed into an annular shape by bending a plate material such as a metal material and butting end edges 138 against each other. A plurality of protruding pieces 142 are disposed around the annular base 136 at intervals. As shown in FIGS. 4 and 12( a ), the seam of the abutted end edges 138 is located at the midpoint between the adjacent protruding pieces 142 .

[0088] A plurality of recesses 137 recessed toward the distal side are formed on the periphery on the base end side of the base 136. The protruding pieces 142 are formed to protrude from bottoms 139 of the recesses 137 toward the base end side. This allows the protruding pieces 142 to be formed long while restricting the size of the locking portion 130 in the axial direction, and allows the protruding pieces 142 to be flexibly deformed when the clip connecting portion 50 of the operating wire 20 is fitted into or removed from the receiving portion 134.

[0089] [Treatment tool body] As shown in any one of Figures 7 to 11, the treatment device main body 90 has a long sheath 10, an operating wire 20 that is inserted into the inside of the sheath 10 so as to be movable back and forth and has a clip connecting portion 50 at its distal end, a cylindrical reduced-diameter sleeve 70 that can be stored inside the sheath 10 and accommodates the clip connecting portion 50, and a transmission portion (e.g., an extension portion 80) that transmits forward and backward forces from the operating wire 20 to the reduced-diameter sleeve 70.

[0090] The reduced diameter sleeve 70 has an expanded diameter portion 72 that is elastically self-expandable, and a tubular sleeve body 76 that is located proximal to the expanded diameter portion 72 and has higher radial rigidity than the expanded diameter portion 72. Here, the radial rigidity of the sleeve body 76 being higher than the radial rigidity of the expanded diameter portion 72 means that when a force is applied radially inward to the sleeve body 76 and the expanded diameter portion 72, the amount of radially inward displacement due to elastic deformation is smaller for the sleeve body 76 than for the expanded diameter portion 72.

[0091] The specific structure of the treatment tool main body 90 included in the clip device 100 is not particularly limited. Fig. 7 illustrates the treatment tool main body 90 including a finger ring 92, a slider 94, and a main body shaft 96. A user of the clip device 100 operates the clip device 100 by, for example, hooking a finger (e.g., thumb) on the finger ring 92 and holding the slider 94 with other fingers (e.g., index finger and middle finger) and moving the slider 94 relative to the main body shaft 96. This causes the operation wire 20 connected to the slider 94 to move forward and backward inside the sheath 10.

[0092] Furthermore, by rotating the entire treatment tool body 90 about its axis, the operation wire 20 rotates together with the slider 94. When the sheath 10 is in close contact with the wall surface of the forceps hole of the endoscope, the operation wire 20 rotates about its axis inside the sheath 10. Hereinafter, the axial rotation of the treatment tool body 90, the operation wire 20, and the clip 110 may be referred to as "torque rotation."

[0093] The clip device 100 is used by inserting the clip 110 into a forceps hole (not shown) of an endoscope with the clip 110 connected to the tip of the operating wire 20. Specifically, the clip device 100 can be used to ligate biological tissue by inserting the sheath 10 from the proximal side into the forceps hole of an endoscope placed in a body cavity, protruding the distal end of the sheath 10 from the distal opening of the forceps hole, and further exposing the clip 110 from the sheath 10. Examples of biological tissue to be ligated include mucosal walls such as a site to be treated in endoscopic submucosal dissection (ESD), as well as body ducts such as blood vessels.

[0094] Next, as shown in Fig. 7 and Fig. 8(a) and the like, the sheath 10 of the treatment tool main body 90 is a long, flexible tubular member. The sheath 10 is longer than the forceps hole of an endoscope used together with the clip device 100. The sheath 10 can be configured, for example, of a coil layer (not shown) in which a metal wire is wound long. An inner layer (not shown) made of a fluorine-based polymer may be provided on the inner peripheral surface of the coil layer. The sheath 10 may also be a coil layer in which a resin wire is wound, or a flexible resin tube.

[0095] The inner diameter of the sheath 10 is large enough to slidably accommodate the centering portion 60 (FIG. 8(a) etc.) provided at the tip of the operating wire 20. The sheath 10 can accommodate the clip 110 in a closed arm state therein (see FIGS. 11(b) and (c)). Specifically, the inner diameter of the sheath 10 is, for example, not less than 100 μm and not more than 2400 μm. The thickness of the sheath 10 is, for example, not less than 100 μm and not more than 350 μm. This can improve the flexibility of the sheath 10.

[0096] The operation wire 20 is inserted through the sheath 10 and can be advanced and retreated in the axial direction inside the sheath 10. The operation wire 20 is made of a metal material with high rigidity, such as stainless steel, a steel wire with a corrosion-resistant coating, titanium, a titanium alloy, etc. Examples of the metal material constituting the metal plate include, but are not limited to, stainless steel, titanium, a titanium alloy, etc.

[0097] The distal end of the operating wire 20 is provided with, for example, a centering portion 60, a support portion 56, a clip connecting portion 50, an expandable portion 80, and a diameter reducing sleeve 70. The centering portion 60 is a block having a larger diameter than the operation wire 20, and is fixed to the distal end of the operation wire 20. The centering portion 60 includes a cylindrical portion (cylindrical portion), and the outer diameter of the cylindrical portion is formed to be equal to and slightly smaller than the inner diameter of the sheath 10. As the operation wire 20 is advanced and retreated inside the sheath 10, the centering portion 60 slides and advances and retreats inside the sheath 10. At this time, since the outer diameter of the centering portion 60 is approximately the same as the inner diameter of the sheath 10, the operation wire 20 advances and retreats while remaining located near the axis of the sheath 10. Even when the sheath 10 is inserted into a forceps hole of a curved endoscope (not shown), the operation wire 20 is located approximately on the center line of the forceps hole, so that the path length of the operation wire 20 does not change, and the clip connecting portion 50 and the clip 110 are prevented from unexpectedly protruding from the sheath 10.

[0098] A support portion 56 is formed coaxially with the operating wire 20 at the distal end of the operating wire 20, distal to the centering portion 60. A clip connecting portion 50 is integrally formed at the distal end of the support portion 56. A constricted portion 51 is formed between the support portion 56 and the clip connecting portion 50 (see FIG. 8(a) etc.). The extendable portion 80 is provided around the support portion 56 so as to accommodate the support portion 56, and the clip connecting portion 50 can be accommodated inside the reduced diameter sleeve 70.

[0099] A second inclined surface 54 is provided on the distal portion of the clip connecting portion 50. As a result, when the clip connecting portion 50 is pressed against the protruding portion 140 from the base end side, the second inclined surface 54 causes the protruding portion 140 to elastically deform outward.

[0100] In addition, a first inclined surface 52 is provided on the proximal portion of the clip connecting portion 50. With this, when the clip connecting portion 50 is received in the receiving portion 134 and the operating wire 20 is pulled toward the proximal side in the advance / retract direction, the first inclined surface 52 deforms the protrusion portion 140 outward.

[0101] One or both of the first inclined surface 52 and the second inclined surface 54 may be flat or curved. If curved, the curved surface may be a convex surface that bulges outward in the radial direction so that the protrusion 140 can be appropriately pushed outward. At least one of the first inclined surface 52 and the second inclined surface 54 has a conical surface shape such as a truncated cone or a truncated pyramid. More specifically, the first inclined surface 52 is a truncated cone surface that tapers toward the proximal side, and the second inclined surface 54 is a truncated cone surface that tapers toward the distal side.

[0102] A cylindrical reduced-diameter sleeve 70 is provided at the distal end of the operating wire 20, which can be housed inside the sheath 10 and which houses the clip connecting portion 50. The inner diameter of at least a portion of the reduced-diameter sleeve 70 is smaller than the outer diameter of the locking portion 130 when the clip connecting portion 50 can be pulled out of the receiving portion 134.

[0103] The reduced-diameter sleeve 70 is a member for restricting the backward movement of the fastening ring 150 relative to the sheath 10 and transitioning the clip 110 from an open arm state (see FIG. 4) to a closed arm state (see FIG. 12). The reduced-diameter sleeve 70 can be stored inside the sheath 10 as shown in FIG. 8(a) and the like, and a part of the reduced-diameter sleeve 70 (enlarged diameter portion 72) can be protruded from the sheath 10 by advancing the operating wire 20 (see FIG. 9(b) and the like).

[0104] The reduced diameter sleeve 70 has an enlarged diameter portion 72, a reduced diameter step portion 74, and a sleeve body 76. The enlarged diameter portion 72 is provided on the distal side of the reduced diameter sleeve 70 and is elastically self-expandable. The reduced diameter step portion 74 is provided on the proximal side of the enlarged diameter portion 72. The sleeve body 76 is provided further proximal than the reduced diameter step portion 74 and has higher radial rigidity than the enlarged diameter portion 72. 10(b), the inner diameter of the sleeve body 76 is smaller than the outer diameter of the locking portion 130 when the clip connecting portion 50 can be pulled out of the receiving portion 134. Therefore, in a state in which the locking portion 130 and the clip connecting portion 50 are connected and in a state in which the protrusion 140 and the protruding piece portion 142 are housed in the sleeve body 76, the sleeve body 76 restrains the outward deformation of the protruding piece portion 142, so that the clip connecting portion 50 is prevented from detaching from the receiving portion 134. However, by retracting at least a portion of the projection 140 and the protruding piece 142 from the sleeve body 76 , the protruding piece 142 is sufficiently deformed to enable the clip connecting portion 50 to be pulled out of the receiving portion 134 .

[0105] The reduced diameter step portion 74 is formed between the sleeve body 76 and the enlarged diameter portion 72 in a tapered shape that reduces in diameter toward the proximal side. The material of the reduced diameter sleeve 70 is not limited to a specific material as long as it is a member that can be reduced in diameter by an external force. For example, a metal material, a resin, or an elastomer such as rubber can be used.

[0106] The reduced diameter sleeve 70 is a cylindrical body (pipe) made of a metal material such as stainless steel, and has one or more slits (not shown) cut from the distal end of the enlarged diameter portion 72 toward the proximal side. The slit may be formed to a length that reaches the reduced diameter step portion 74. By having such a slit, at least the enlarged diameter portion 72 of the reduced diameter sleeve 70 is configured to be capable of undergoing deformation to expand or contract. When the reduced diameter sleeve 70 is housed in the sheath 10 and constrained by the sheath 10 as shown in FIG. 8(a) and the like, the enlarged diameter portion 72 is deformed to be contracted in diameter compared to when it is in a natural state (FIG. 9(b) and the like) not constrained by the sheath 10, and the outer diameter is smaller than the inner diameter of the sheath 10.

[0107] 9(b) and other figures, the expanded diameter portion 72 of the reduced diameter sleeve 70 protrudes distally from the sheath 10, causing the expanded diameter portion 72 to elastically return to its natural state. The expanded diameter portion 72 has a diameter larger than the inner diameter of the sheath 10 in its natural state. The sleeve main body 76 has a diameter smaller than the inner diameter of the sheath 10 in its natural state, and the reduced diameter step portion 74 has a portion with a larger diameter than the inner diameter of the sheath 10 and a portion with a smaller diameter than the inner diameter of the sheath 10 in its natural state.

[0108] The expansion / contraction section (transmission section) 80 is a member that connects the centering section 60 and the reduced diameter sleeve 70, and is configured to be expandable and contractible in the axial direction. The expandable portion 80 can be made of a coil made of a metal or resin wire wound in a spiral, or an elastomer such as rubber. As the wire, a metal wire such as stainless steel or tungsten can be preferably used. In this embodiment, the expansion and contraction portion 80 is configured by a coil.

[0109] The expandable section 80 is a coil wound with an unequal pitch, with the winding pitch at both ends fixed to the centering section 60 and the reduced diameter sleeve 70 being smaller and the winding pitch at the middle section being larger than those at both ends. More specifically, both ends of the expandable section 80 are wound in a dense manner with adjacent winding loops in contact with each other, and the middle section of the expandable section 80 is wound with a pitch winding with adjacent winding loops spaced apart from each other.

[0110] The reduced diameter sleeve 70 is a tubular member fixed to the telescopic portion 80, and the operating wire 20, the telescopic portion 80, and the reduced diameter sleeve 70 are arranged coaxially with the sheath 10. The sleeve body 76 of the reduced diameter sleeve 70 is housed in the telescopic portion 80. The distal end of the telescopic portion 80 abuts against the proximal side of the reduced diameter step portion 74. The distal portion of the telescopic portion 80 includes a fixing portion 82 fixed to the periphery of the sleeve body 76, and a non-fixed portion 84 located distal to the fixing portion 82 and attached non-fixedly to the periphery of the sleeve body 76. The fixing portion 82 is fixed to the periphery of the sleeve body 76 by adhesive, metal brazing such as solder, or welding.

[0111] In the above, an example has been described in which the tip of the operating wire 20 is connected (jointed) to the base end of the extension / contraction section 80 via the centering section 60, but the tip of the operating wire 20 may also be directly connected (jointed) to the base end of the extension / contraction section 80. As an example, a structure can be exemplified in which the portion of the expansion section 80 made of a coil toward the base end side relative to the reducing sleeve 70 is formed into a tapered spiral shape in which the inner and outer diameters gradually reduce toward the base end of the expansion section 80. In this case, for example, the inner diameter of the spiral-shaped portion can be set equal to the outer diameter of the tip of the operating wire 20, and the inner surface of the spiral-shaped portion can be joined to the outer surface of the tip of the operating wire 20, thereby connecting the operating wire 20 and the extension / contraction portion 80 to each other.

[0112] [Procedure] Next, a series of procedures for connecting the clip connecting portion 50 of the operation wire 20 to the clip 110 will be described with reference to each of Figs. 8 to 11. First, as shown in FIGS. 8( a ) and 8 ( b ), the sheath 10 of the treatment tool body 90 is inserted into the insertion hole 43 of the outer case 40 of the cartridge 200 until the tip of the sheath 10 abuts against the stopper portion 44 . With the treatment tool main body 90 inserted into the insertion hole 43, the operating wire 20 is pushed forward, causing the clip connecting portion 50 and the expanded diameter portion 72 of the sleeve to protrude from the sheath 10 toward the tip side and enter the area between the inner case 30 and the insertion hole 43 in the second accommodating area 42, and the expanded diameter portion 72 elastically expands in diameter.

[0113] As shown in Figure 9 (c), by pushing the operating wire 20 further forward, the clip connecting portion 50 moves forward relative to the reduced-diameter sleeve 70, protruding from the reduced-diameter sleeve 70 toward the tip side, and the clip connecting portion 50 and the engaging portion 130 are connected to each other.

[0114] Furthermore, when the tip of the enlarged diameter portion 72 hits the forward movement restricting portion 322, the further forward movement of the reduced diameter sleeve 70 is restricted, and thereafter, the clip connecting portion 50 selectively moves forward between the reduced diameter sleeve 70 and the clip connecting portion 50. In addition, since the inner case 30 can slide back and forth relative to the outer case 40, the inner case 30 can move forward relative to the outer case 40 when the operating wire 20 is pushed in, but the forward movement of the inner case 30 is restricted at the front end position of the second accommodating area 42.

[0115] As shown in Figures 10(a) to 11(a), when the operating wire 20 is pulled toward the base end in the connected state, the base end of the clip 110 is pulled slightly into the reduced-diameter sleeve 70, and the inner case 30 and the clip 110 are pulled toward the sheath 10. Specifically, regarding the traction of the operation wire 20, in order to retract the operation wire 20 relatively to the sheath 10, the user elastically deforms the insertion portion (insertion hole 43) of the cartridge 200 through which the sheath 10 is passed, and traction the operation wire 20 in a state in which the protrusion 46 formed on the insertion portion is pressed against the sheath 10. In this way, the frictional force applied from the protrusion 46 to the sheath 10 can be increased, and the operation wire 20 can be retracted relatively to the sheath 10. Then, as the inner case 30 presses the reduced diameter sleeve 70 rearward, the reduced diameter sleeve 70 retreats until the enlarged diameter portion 72 abuts against the surrounding wall 425, and then the enlarged diameter portion 72 is drawn into the sheath 10 while reducing in diameter.

[0116] At this time, the tightening ring 150 pushes the inclined surface 318 backward, causing the inner case 30 to move backward, and the reduced-diameter sleeve 70 is pushed backward by the forward movement restricting portion 322 of the inner case 30 and moves backward. Also, the pair of arms 120 of the clip 110 are drawn into the tightening ring 150 while slightly closing, but do not achieve ligation. At this time, the inner case 30 retreats relative to the outer case 40 within the second housing area 42, and the inner case 30 presses the reduced diameter sleeve 70 rearward, causing the enlarged diameter portion 72 to be drawn into the insertion hole 43 while reducing in diameter.

[0117] Here, the magnitude of the force required to close and ligate the pair of arms 120 by fastening ring 150 is, for example, about 30 N to 50 N, whereas the magnitude of force F1 required to detach clip 110 rearward from inner case 30 is, for example, about 10 N. Force F1 is the force required to detach fastening ring 150 rearward from the ring clamping portion. Therefore, by pulling the operating wire 20 with a force equal to or greater than the force F1, the clip 110 is pulled by the clip connecting portion 50 and detached from the inner case 30 and moved back, but does not result in ligation (see FIG. 11(b)).

[0118] Here, the magnitude of the force F2 required to pull the enlarged diameter portion 72 of the reduced diameter sleeve 70 from the second accommodating region 42 into the sheath 10 is, for example, about 2N or more and 3N or less. Moreover, the force F3 required to move the inner case 30 backward relative to the outer case 40 in the second housing area 42 is sufficiently smaller than the force F2.

[0119] That is, the cartridge 200 is configured such that, when the operating wire 20 is pulled toward the base end in the connected state, the clip 110 is pulled by the clip connecting portion 50, thereby detaching and retracting from the inner case 30. The force F1 required to detach the clip 110 from the inner case 30, the force F2 required to retract the enlarged diameter portion 72 of the reducing sleeve 70 from the second accommodating region 42 into the sheath 10, and the force F3 required to retract the inner case 30 relatively to the outer case 40 in the second accommodating region 42 satisfy F1>F2>F3. Therefore, the operating wire 20 pulls the inner case 30 via the fastening ring 150, whereby the inner case 30 is moved backward, and the expanded diameter portion 72 can be pulled into the sheath .

[0120] As described above, a force of about 30 N to 50 N is required to completely ligate (finally tighten) clip 110, and therefore, before final tightening, enlarged portion 72 of reduced-diameter sleeve 70 is reduced in diameter and stored in sheath 10. Furthermore, before final tightening, fastening ring 150 and clip 110 are stored in sheath 10 (FIG. 11(b)). Thereafter, the sheath 10 is pulled out from the cartridge 200 (FIG. 11(c)). With the above, the loading of the clip 110 into the treatment tool body 90 is completed.

[0121] Here, when the operating wire 20 is pulled toward the base end in the connected state, the locking portion 130 and the clip connecting portion 50 of the clip 110 are stored inside the sleeve body 76 of the diameter-reducing sleeve 70 before the enlarged portion 72 is retracted into the sheath 10 (see FIG. 10(a)). Therefore, the enlarged portion 72 can be retracted into the sheath 10 while maintaining the connected state.

[0122] More specifically, clip 110 includes a fastening ring 150 into which multiple arms 120 are inserted together, and is configured such that the tips of multiple arms 120 are closed to each other by moving fastening ring 150 toward the tips of arms 120 relative to arms 120. The inner case 30 has a ring clamping portion (e.g., a movable piece 321) that clamps the tightening ring 150, and is configured so that when the operating wire 20 is pulled toward the base end in the connected state, the ring clamping portion elastically deforms and the tightening ring 150 detaches from the ring clamping portion. And, force F1 is the force required to separate the fastening ring 150 from the ring clamping portion.

[0123] Here, the force required to remove the fastening ring 150 from the ring clamping portion is the resultant force of various forces required to remove the fastening ring 150 from the ring clamping portion. The forces constituting the resultant force include a force required to separate the fastening ring 150 from the ring clamping portion. This force is a force required for the fastening ring 150 to be pulled toward the base end side, so that the fastening ring 150 moves toward the base end side by frictionally sliding against the pair of movable pieces 321, for example, while expanding the opposing gap between the pair of movable pieces 321. Furthermore, the resultant force also includes a force required to release the clip 110 from the first housing area 32 toward the base end side. That is, since the arm portions 120 of the clip 110 have a self-expanding force, when the clip 110 is released rearward from the first housing area 32, frictional resistance (resistance force) caused by the self-expanding force is generated between the arm portions 120 and the inner wall surface of the first housing area 32 in the inner case 30. Therefore, this resistance force is also included in the resultant force. The resultant force includes forces due to friction of each part in addition to the above.

[0124] More specifically, the ring clamping portion has a ring retaining recess 317 that holds the tightening ring 150 in a fitted state, and an inclined surface 318 adjacent to the base end side of the ring retaining recess 317, which is inclined in a direction such that the distance between the ring clamping portions narrows toward the base end side.

[0125] More specifically, the inner case 30 has an inner case main body (e.g., a portion of the inner case component 31 excluding the movable piece 321) and a ring clamping portion, and the ring clamping portion includes the movable piece 321 supported in a cantilever manner by the inner case main body (in this embodiment, the movable piece 321 itself is the ring clamping portion). When the operating wire 20 is pulled toward the base end in the connected state, the movable pieces 321 are elastically displaced in a direction in which the opposing gap between the ring clamping portions (i.e., the movable pieces 321) increases, causing the fastening ring 150 to detach from the inner case 30. In other words, the pair of movable pieces 321 are elastically deformed in directions away from each other, causing the fastening ring 150 to detach from the inner case 30.

[0126] 6, in the movable piece 321, an outer surface 324 facing the inner surface of the outer case 40 is inclined toward the base end in a direction away from the inner surface of the outer case 40. As a result, a space is secured between the outer surface 324 and the inner surface of the outer case 40 so that the pair of movable pieces 321 can elastically displace in a direction in which the opposing distance between them increases.

[0127] Next, a series of procedures from closing the clip 110 to detaching the clip 110 from the clip connecting portion 50 will be described.

[0128] As shown in Fig. 11(c), with the clip 110 housed in the sheath 10, the sheath 10 is inserted into the body cavity through the forceps hole of the endoscope. When the distal end of the sheath 10 reaches the vicinity of the biological tissue that needs to be ligated, the operating wire 20 is pushed distally. This causes the clip 110 and the fastening ring 150 to protrude from the tip of the sheath 10, and the clip 110 naturally expands to the maximum opening width by its own expansion force.

[0129] At this time, at least the enlarged diameter portion 72 and the enlarged diameter step portion 74 of the enlarged diameter sleeve 70 protrude from the distal opening of the sheath 10, and are deformed to expand to their natural diameter. Next, the position and orientation of the clip 110 are adjusted with respect to the biological tissue to be ligated.

[0130] When the treatment tool main body 90 (see FIG. 1) is torque-rotated, the operation wire 20 and the clip connecting part 50 are torque-rotated in conjunction with each other. Furthermore, since the clip connecting part 50 transmits the torque to the locking part 130, the arm part 120 of the clip 110 is also torque-rotated. This allows the opening direction of the arm part 120 to be directed in a desired direction with respect to the ligation site of the biological tissue.

[0131] After the position and orientation of the clip 110 are determined, the operating wire 20 is retracted proximally while the tip of the clip 110 is pressed against the ligation site. The tightening ring 150 abuts against the inner surface of the reduced diameter step portion 74 and is fitted inside the enlarged diameter portion 72, restricting backward movement relative to the reduced diameter sleeve 70 and the sheath 10. Furthermore, since the tightening ring 150 is fitted into the enlarged diameter portion 72, the enlarged diameter portion 72 is prevented from being deformed by reducing its diameter even if an external force is applied to the enlarged diameter portion 72, and the enlarged diameter portion 72 is prevented from being retracted into the sheath 10 even if the operating wire 20 is retracted proximally with a large force.

[0132] The operating wire 20 and the reduced diameter sleeve 70 are connected by the stretchable portion 80. Therefore, even after the relative movement of the reduced diameter sleeve 70 toward the proximal side with respect to the clip device 100 is restricted, the stretchable portion 80 can be extended by retracting the operating wire 20 toward the proximal side, and the clip connecting portion 50 can be further retracted toward the proximal side within the sheath 10.

[0133] With the clip connecting portion 50 received in the receiving portion 134, the operation wire 20 is pulled proximally in the forward / backward direction, causing the arms 120 to close (see FIGS. 12(a) and 12(b)) and grasp the biological tissue. It is also possible to interrupt the retraction while the arms 120 are closing and push the operation wire 20 in again to open the arms 120 again. Then, after optimal ligation has been confirmed, when the operation wire 20 is further retracted proximally, the tightening ring 150 fits into the narrow portion 123 provided on the arms 120, locking the clip 110. This causes the clip 110 to enter a closed arm state.

[0134] When the arms 120 are closed to grasp the biological tissue, the protrusion 140 of the locking portion 130 is housed inside the reduced-diameter sleeve 70. By further pulling the operating wire 20 proximally from this state, the protrusion 140 protrudes from the sleeve body 76 of the reduced-diameter sleeve 70 toward the base end, and becomes capable of being significantly deformed outward. Here, "the protrusion 140 is significantly deformed" means that the protrusion 140 is deformed to a large diameter at least until the clip connecting portion 50 can be pulled out of the receiving portion 134. Therefore, following the operation of retracting the slider 94 when ligating the biological tissue, the slider 94 is further retracted to remove the clip connecting part 50 from the locking part 130. As a result, the clip 110 is separated from the operating wire 20 and is placed in the body cavity with the biological tissue ligated.

[0135] This completes a series of procedures including connecting the clip connecting part 50 to the clip 110, closing the arms of the clip 110, and detaching the clip connecting part 50 from the clip 110. By repeating the above procedures, biological tissue can be ligated with a large number of clips 110.

[0136] <Modification> Next, a cartridge 201 according to a modified example will be described with reference mainly to Fig. 13. As described above, Fig. 13 is a plan view of the cartridge 201 according to the modified example. 13, a slit 47 is formed in the thin-walled portion 431 of the cartridge 201 according to this example, which allows a portion of the thin-walled portion 431 to deform in a direction toward the sheath 10 inserted in the insertion portion (insertion hole 43). In particular, the slit 47 is formed in a shape that surrounds at least a portion of the protrusions 46b, 46c.

[0137] The slit 47 according to this example is formed in an angular C-shape with an open end when viewed in the thickness direction of the cartridge 200. Here, the "enclosed portion" includes the "sandwiched portion", and may be a portion surrounded by an angular C-shaped notch 47, a portion surrounded by a rounded C-shaped notch, or a portion sandwiched between two I-shaped (straight) notches (not shown) extending in the long direction and aligned in the short direction.

[0138] According to the above configuration, the notch 47 is formed in a shape that covers at least a portion of the protrusions 46b, 46c, so that the portion surrounded by the notch 47 bends, and the sheath 10 pressed against that portion can be suitably pressed against the protrusions 46b, 46c. In the cartridge 201 of this example, the portion of the external protrusion 431a shown in FIG. 1 that overlaps with the notch 47 has a shape that is carved away by the notch 47, but this is not limited to such a configuration, and it is preferable that the external protrusion 431a is positioned further inward than the notch 47. In other words, because external protrusion 431a is surrounded by notch 47, if external protrusion 431a is formed in a portion that is formed to be easily bent, for example, in a cantilever-like shape, a user can touch external protrusion 431a and press it, making it easier to bend the portion surrounded by notch 47.

[0139] According to the above embodiment, when the treatment tool main body 90 is inserted into the insertion hole 43, the operating wire 20 is pushed forward, causing the clip connecting portion 50 and the expanded diameter portion 72 of the sleeve to protrude from the sheath 10 toward the tip side and enter the area between the inner case 30 and the insertion hole 43 in the second accommodating area 42, and the expanded diameter portion 72 elastically expands in diameter. Then, as the operating wire 20 is pushed further forward, the clip connecting portion 50 moves forward relative to the sleeve, protruding from the sleeve toward the tip side, and the clip connecting portion 50 and the locking portion 130 are connected to each other.

[0140] Furthermore, when the operating wire 20 is pulled toward the base end in the connected state, the inner case 30 retreats relative to the outer case 40 within the second accommodating area 42, and the inner case 30 presses the sleeve rearward, causing the expanded portion 72 to shrink and be pulled into the sheath 10. Therefore, the clip 110, which has a structure that enables a series of procedures to be easily performed, can be attached to the treatment tool body 90 easily and reliably.

[0141] The present invention is not limited to the above-described embodiment, but includes various modifications and improvements as long as the object of the present invention is achieved.

[0142] For example, in the above embodiment, an example has been described in which the clip connecting portion 50 is in a block shape and is housed in the claw-shaped locking portion 130 at the base end of the clip 110. Conversely to this example, the clip connecting portion 50 formed in a claw shape may be configured to hold the locking portion 130 at the base end of the clip 110 by wrapping around it.

[0143] It is not necessary for each component of the cartridge 200 of the present invention to be an independent entity. It is acceptable for multiple components to be formed as a single member, for one component to be formed from multiple members, for one component to be a part of another component, or for part of one component to overlap with part of another component.

[0144] The above embodiment encompasses the following technical ideas. (1) A cartridge is used to connect a clip to a long treatment instrument body including a sheath formed long and capable of accommodating a clip, and an operation wire inserted inside the sheath so as to be movable forward and backward in an axial direction of the sheath, the operation wire having a clip connecting portion at a distal end thereof which is connected to the clip, the cartridge including a housing portion for housing the clip, an insertion portion is formed which is connected to the housing portion and extends long and into which the sheath is inserted; The insertion section is configured to be elastically deformable so as to narrow its inner cavity, A protrusion is formed on a wall surface that defines the insertion portion, The cartridge is characterized in that the protrusion protrudes toward the sheath inserted into the insertion portion, and is formed to allow the operating wire to move back and forth while restricting the movement of the sheath when an external force is applied and the insertion portion is elastically deformed. (2) The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion; a step portion provided at a boundary between the thick portion and the thin portion; and a fitting portion that fits into the other case piece, The thick portion and the thin portion are overlapped so as to face each other, The fitting portions are provided side by side, at least one on each side of the insertion portion in a direction intersecting a direction in which the insertion portion extends, The cartridge according to (1), wherein at least a portion of the step portion extends parallel to a direction in which the fitting portions are arranged. (3) The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion; a step portion provided at a boundary between the thick portion and the thin portion, The thick portion and the thin portion are overlapped so as to face each other, A cartridge according to (1) or (2), wherein an end of the step portion located on the central side of the thin-walled portion in the extending direction of the insertion portion extends in a direction perpendicular to the extending direction of the insertion portion. (4) The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion; a step portion provided at a boundary between the thick portion and the thin portion, The thick portion and the thin portion are overlapped so as to face each other, An opening is formed on both side surfaces of the cartridge in a direction perpendicular to the thickness direction of the cartridge, the opening is between the thin-walled portions of the two case halves and is partially defined by the step portion, The cartridge according to any one of (1) to (3), wherein at least both ends of the step portion extend in a direction perpendicular to the both side surfaces. (5) The protrusion is provided in a plurality of portions along an extension direction of the insertion portion, a central portion of the step portion in a direction perpendicular to the extending direction of the insertion portion and perpendicular to the thickness direction of the cartridge is inclined toward an outer side in the extending direction of the insertion portion as it approaches the insertion portion from both end portions; The cartridge according to (4), wherein at least one of the plurality of protrusions is provided at a position overlapping a region connecting the two end portions of the step portion when viewed in the thickness direction of the cartridge. (6) The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion, abutting portion that abuts against one of the two case pieces and limits the bending of the thin-walled portion when the thin-walled portion is bent is provided on the other of the two case pieces; The thick portion and the thin portion are overlapped so as to face each other, The protrusion is provided in a plurality of portions along an extension direction of the insertion portion, The cartridge according to any one of (1) to (5), wherein the abutting portions are provided on both sides of at least one of the plurality of protrusions in a direction perpendicular to a direction in which the insertion portion extends. (7) The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion, an external protrusion protruding outward in a thickness direction of the cartridge or a recess recessed inward in a thickness direction of the cartridge is provided at a central portion of the thin-walled portion in a direction in which the insertion portion extends; The cartridge according to any one of (1) to (6), wherein the external protrusion or recess is arranged so as to surround at least a portion of the protruding portion when viewed in a thickness direction of the cartridge. (8) an external protrusion provided at the central portion of the thin-walled portion protruding outward in a thickness direction of the cartridge; The protrusion is provided in a plurality of portions along an extension direction of the insertion portion, The cartridge according to (7), wherein at least one of the plurality of protrusions is formed at a position overlapping a region where the external protrusion is formed when viewed in the thickness direction of the cartridge. (9) The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion, a slit is formed in the thin-walled portion to allow a part of the thin-walled portion to deform in a direction toward the sheath inserted in the insertion portion, The cartridge according to any one of (1) to (8), wherein the notch is formed in a shape that surrounds at least a portion of the protrusion. (10) A cartridge described in any one of (1) to (9), wherein the insertion side of the sheath in the protrusion extends in a direction perpendicular to the extension direction of the insertion portion, and the retraction side of the protrusion, which is the opposite side of the insertion side, is tapered so that its width narrows toward the retraction side. (11) The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion; and a fitting portion that fits into the other case piece, The thin-walled portion is formed to bend when a load of 1 N or more and 15 N or less is applied, thereby restricting movement of the sheath while allowing the operation wire to move back and forth. (12) A cartridge according to any one of (1) to (11), The treatment tool body, A clip cartridge system comprising: a clip accommodated in the accommodation portion. [Explanation of symbols]

[0145] 10 Sheath 20 Control wire 30 Inner case 31 Inner case components 32 First Containment Area 311 Plate-shaped part 312 Protrusion 313 Hole 314 Recess 315 Side wall 316 Adjacent Wall 317 Ring Retaining Recess 318 Slope 319 Locking part receiving recess 320 Slit 321 Movable piece 322 Forward Control Section 323 Notched section 324 Exterior 40 Outer case 41 Outer case components (case pieces) 42 Second storage area (storage section) 43 Insertion hole (insertion part) 44 Stopper part 45 Opening 46(46a, 46b, 46c, 46d, 46e) Protrusion 47 Cut 411 Plate-shaped part 412 Protrusion 413 Guide protrusion 414 Protrusion 415 Hole 416 Protrusion 417 Notched section 418 Through hole configuration groove 418a Groove body 418b Wide section 418c Wall 419 Stopper component 420 Notched section 421 Tip wall 422 Side wall (side) 423 Ridge 424 Recess 425 Perimeter Wall 426 Intermediate protrusion (butting part) 427 Hole 428 Locking claw 429 Hole 430 Thick wall part 431 Thin section 431a External projection 432 Step 432a End (the end of the thin-walled part at the center) 432b central part 432X Outside step 432Y Inner step 433 Fitting part 50 Clip connection part 51 Hanging Part 52 1st slope 54 Second slope 56 Pillar section 60 Centering section 70 Reduced diameter sleeve (sleeve) 72 Expanded diameter part 74 Reduced diameter step 76 Sleeve body 80 Telescopic section (transmission section) 82 Attachment 84 Non-fixed part 90 Treatment tool body 92 Finger Ring 94 Slider 96 Main shaft 100 Endoscopic clipping device 110 clips 110a Clip body 120 Arm 121 Thick part 122 Proximal end 123 Narrow part 124 Arm body 125 Reinforcement 126 Claw 130 Locking part 132 Space 134 Receptor 136 Base 137 Recess 138 Edge 139 Bottom 140 Protrusion 142 Projection piece 150 Fastening ring 200, 201 Cartridges 200S Clip Cartridge System

Claims

1. A cartridge is used to connect a clip to a long treatment instrument body including a sheath formed long and capable of accommodating a clip, and an operation wire inserted inside the sheath so as to be movable forward and backward in an axial direction of the sheath, the operation wire having a clip connecting portion at a distal end thereof which is connected to the clip, the cartridge including a housing portion for housing the clip, an insertion portion is formed which is connected to the housing portion and extends long and into which the sheath is inserted; The insertion section is configured to be elastically deformable so as to narrow its inner cavity, A protrusion is formed on a wall surface that defines the insertion portion, the protrusion protrudes toward the sheath inserted into the insertion portion, and is formed to allow the operation wire to move back and forth while restricting movement of the sheath when an external force is applied to the insertion portion and the insertion portion is elastically deformed, The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion; a step portion provided at a boundary between the thick portion and the thin portion, The thick portion and the thin portion are overlapped so as to face each other, The protrusion is provided in a plurality of portions along an extension direction of the insertion portion, Both ends of the step portion extend in a direction perpendicular to the extension direction of the insertion portion, a central portion of the step portion in a direction perpendicular to an extension direction of the insertion portion and perpendicular to a wall thickness direction of the cartridge is inclined toward the storage portion as it approaches the insertion portion from both end portions, A cartridge, characterized in that at least one of the plurality of protrusions is provided at a position overlapping a region connecting both ends of the step portion when viewed in a thickness direction of the cartridge.

2. A cartridge is used to connect a clip to a long treatment instrument body including a sheath formed long and capable of accommodating a clip, and an operation wire inserted inside the sheath so as to be movable forward and backward in an axial direction of the sheath, the operation wire having a clip connecting portion at a distal end thereof which is connected to the clip, the cartridge including a housing portion for housing the clip, an insertion portion is formed which is connected to the housing portion and extends long and into which the sheath is inserted; The insertion section is configured to be elastically deformable so as to narrow its inner cavity, A protrusion is formed on a wall surface that defines the insertion portion, the protrusion protrudes toward the sheath inserted into the insertion portion, and is formed to allow the operation wire to move back and forth while restricting movement of the sheath when an external force is applied to the insertion portion and the insertion portion is elastically deformed, A cartridge characterized in that the insertion side of the sheath at the protrusion extends in a direction perpendicular to the extension direction of the insertion portion, and the retraction side of the protrusion, which is the opposite side of the insertion side, is tapered so that its width narrows as it approaches the retraction side.

3. The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion; a step portion provided at a boundary between the thick portion and the thin portion; and a fitting portion that fits into the other case piece, The thick portion and the thin portion are overlapped so as to face each other, The fitting portions are provided side by side, at least one on each side of the insertion portion in a direction intersecting a direction in which the insertion portion extends, The cartridge according to claim 1 or 2, wherein at least a part of the step portion extends parallel to the direction in which the fitting portions are arranged.

4. The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion; a step portion provided at a boundary between the thick portion and the thin portion, The thick portion and the thin portion are overlapped so as to face each other, 4. A cartridge according to claim 1, wherein an end of the step portion on a central side of the thin portion in the extending direction of the insertion portion extends in a direction perpendicular to the extending direction of the insertion portion.

5. The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion; a step portion provided at a boundary between the thick portion and the thin portion, The thick portion and the thin portion are overlapped so as to face each other, An opening is formed on both side surfaces of the cartridge in a direction perpendicular to the thickness direction of the cartridge, the opening is between the thin-walled portions of the two case halves and is partially defined by the step portion, 5. A cartridge according to claim 1, wherein at least both ends of the step portion extend in a direction perpendicular to the both side surfaces.

6. The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion, abutting portion that abuts against one of the two case pieces and limits the bending of the thin-walled portion when the thin-walled portion is bent is provided on the other of the two case pieces; The thick portion and the thin portion are overlapped so as to face each other, The protrusion is provided in a plurality of portions along an extension direction of the insertion portion, The cartridge according to claim 1 , wherein the abutment portions are provided on both sides of at least one of the plurality of protrusions in a direction perpendicular to a direction in which the insertion portion extends.

7. The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion, an external protrusion protruding outward in a thickness direction of the cartridge or a recess recessed inward in a thickness direction of the cartridge is provided at a central portion of the thin-walled portion in a direction in which the insertion portion extends; The cartridge according to claim 1 , wherein the external protrusion or recess is disposed so as to surround at least a part of the protruding portion when viewed in a thickness direction of the cartridge.

8. an external protrusion provided at the central portion of the thin-walled portion protruding outward in a thickness direction of the cartridge; The protrusion is provided in a plurality of portions along an extension direction of the insertion portion, The cartridge according to claim 7 , wherein at least one of the plurality of protrusions is formed at a position overlapping a region in which the external protrusion is formed when viewed in the thickness direction of the cartridge.

9. The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion, a slit is formed in the thin-walled portion to allow a part of the thin-walled portion to deform in a direction toward the sheath inserted in the insertion portion, 9. The cartridge according to claim 1, wherein the notch is formed in a shape surrounding at least a portion of the protrusion.

10. The cartridge includes two plate-shaped case pieces that are assembled in a thickness direction, The two case pieces are: A thick portion; a thin-walled portion formed continuously with the thick-walled portion to define at least a portion of the insertion portion; and a fitting portion that fits into the other case piece, 10. A cartridge according to claim 1, wherein the thin-walled portion is formed to bend when a load of 1 N or more and 15 N or less is applied thereto, thereby restricting movement of the sheath while allowing the operation wire to move back and forth.

11. A cartridge according to any one of claims 1 to 10; The treatment tool body, A clip cartridge system comprising: a clip accommodated in the accommodation portion.

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