Clip and clipping instrument for biological tissues

A clipping instrument for biological tissues equipped with an outer tube which can be inserted into a biological cavity, an operating member freely passed through the outer tube, an operating wire freely passed though the operating member, a self-opening holder which can be opened and closed by the action of the operating member attached to the edge of the operating wire, and a self-opening clop having a clipping member for clopping a biological tissue which is attached to the edge of the holder in a detachable manner by opening/closing the holder. Using this clopping instrument, a lesion site can be surely clipped over a long period of time in ligating a breeding site in a biological tissue, stitching a laceration, making in excision of a mucosal tissue and so on with an endoscope.

TECHNICAL FIELD

The present invention relates to a clip and a clipping equipment for biological tissues, which are used as a treating equipment for an endoscope for ligating a bleeding site in a biological tissue, stitching a laceration, and marking in excision of a mucosal tissue with an endoscope.

BACKGROUND TECHNIQUE

A clip used as a treating equipment for an endoscope is used in many cases, such as ligating a bleeding site, stitching a laceration, and marking in excision of a mucosal tissue with an endoscope. A clipping equipment for biological tissues disclosed in Japanese Utility Model Application Laid-Open (JP-U) No. 62-170010 is constructed of a clip801having opening habit, a clip securing ring802for closing a clip tip part, and a connecting plate803which is detachable on an operating wire in which a hook is attached to a tip (not shown), as shown inFIG. 35. In this clipping equipment800for biological tissues, when the clipping equipment holds a biological tissue such as a lesion, a connecting plate803is attached to a hook, an opened tip part of a clip801is pushed against a lesion with an endoscope, an operating wire positioned at a cavity of an operating member is pulled, thereby, a clip801is moved so that it is pulled into a clip securing ring802, thereby, an opening part is closed to clip a lesion. And, since a clip801clips a lesion with an opening part on a tip side, a force directed to a basal direction of a clip801is exerted on a clip securing ring802. However, when a biological tissue is ligated once, it is usually necessary to maintain the state where the tissue is clipped for about a few days to one week and, if a tissue immediately comes off, a tissue must be ligated again with a clip. Such the second time treatment is pain to a patient.

In addition, in order to prevent a connecting plate803from protruding from a clip securing ring802, and preventing a clip801from coming out from a hook in the state where a clip801has not completely been closed, a gel-like fixing agent804is filled into a clip securing ring802. However, it is difficult to fill into a cavity of a small clip securing ring802from a viewpoint of manufacturing and, upon clipping a biological tissue, there is a problem that a fixing agent804filled into a cavity of a clip securing ring802is peeled and fallen.

Japanese Patent Application Laid-Open (JP-A) No. 50-75797 discloses a tissue clipping equipment for grasping a tissue in a body with a clip using an endoscope, and dwelling the clip therein. Since in this clipping equipment, a clip is directly mounted on a hook provided on a tip of an operating wire, there is a problem that, when a clip is dwelled, a clipping equipment must be moved forwardly and backwardly, and left and right in order to remove a clip from a hook, thus, a way to use it is troublesome.

JP-U No. 2-6011 discloses a clipping equipment900which overcomes the aforementioned disadvantage, as shown inFIG. 36. This clipping equipment900is equipped with a hook902provided on a tip of an operating wire901, and a connecting member903having an engaging pore904engaging with a pin906of a hook902on one end, and having a crook (not shown) which is connected to a clip and is deformable by stretching on the other end, wherein when a connecting plate903is moved to a hand side via an operating wire901in order to dwell a clip905in a biological tissue, a crook of a connecting plate904is stretched, and the engaging state of a clip905and a connecting plate903is released.

Although this clipping equipment900improved troublesome operation of removing a clip from a hook, since a connecting plate903is engaged with an operating wire901also after clip dwelling, a connecting plate903must be removed after taken out from an endoscope, and there is a problem of disposal of a connecting plate903which has become an unnecessary part. In addition, there is a problem that, since a connecting plate903is small, it is sucked into a sucking port of an endoscope rarely, and this becomes a cause for worse suction. In addition, as a common problem of clipping equipments described in JP-A No. 50-75797 and JP-U No. 2-6011, there is a problem that, when a clip is mounted on a clipping equipment, since a hook is a cantilevered type, balance is worse, and a clip is easily detached from a hook.

On the other hand, JP-U No. 1-77703 shows a clipping equipment in which a ratchet mechanism consisting of an engaging claw and a claw to be engaged of a ratchet is applied. This clipping equipment is such that a pitch of a claw to be engaged is formed finer than that of an engaging claw, or at least two sets of an engaging claw and a claw to be engaged are disposed, and a phase of one of them is shifted without altering a pitch of a claw, and a moving pitch is small-sized as a whole, in which by pulling a wire fixing a clip, and opening a clip to a greatest degree and further pulling a wire, a clip is closed and, finally, a connecting plate is destructed, releasing a clip.

According to this clipping equipment, a movement amount of an operating member can be operated finer by a ratchet mechanism. However, since attachment of a clip and operation of opening are performed by a ratchet mechanism, there is a problem that, in order to assuredly stop a clip at an intended position, an operator must perform position adjusting operation while seeing a clip, and operation is troublesome.

In addition, in a clipping equipment900described in JP-U No. 2-6011, since operation of engaging with a pin906of a hook and a small engaging pore904of a connecting plate903is performed in a dim endoscope chamber, it is difficult to mount a clip905. In addition, since a handle is operated in the state where a pin906is engaged into an engaging pore904, a pin906is detached during handle operation in some cases. Further, in many cases where a lesion must be grasped with a clip, it is difficult to perform rapid operation.

In addition, JP-A No. 2000-335631 discloses a clip packaging body for an endoscope in which a clip for an endoscope can be accommodated between substrates. According to this endoscope packaging body, when sterilization treatment is performed in a packaging body in advance, sterilization working becomes easy. However, in order to mount a clip on a clipping equipment from this clip packaging body for an endoscope, it is necessary to grasp a clip by one hand from above the packaging body in the state where a clip packaging body for an endoscope is opened half, so that a clip is not directly contacted with a hand, and hang a pin of a hook on a small engaging pore of a connecting plate in the state where two members of a handle and an operating member are grasped by the other hand. Such the operation needs a skill and is troublesome.

Therefore, an object of the present invention is to provide a treating equipment clip for an endoscope which can assuredly clip a lesion over a long period of time, in ligating a bleeding site of a biological tissue, stitching a laceration, and marking in excision of a mucosal tissue with an endoscope. In addition, another object of the present invention is to provide a clipping equipment for a biological tissue which does not need seeing a degree of opening of a clip and does not need fine positioning adjustment. In addition, other object of the present invention is to provide a clipping equipment for a biological tissue which does not need troublesome operation for mounting and removing a clip.

DISCLOSURE OF THE INVENTION

That is, the present invention provides a clip comprising a self-opening clip body having a clipping part on a tip and provided with a twin-arm part extending from a basal part, and a securing ring, wherein the self-opening clip body has a first concave part on a clip basal part, and a second concave part between the first concave part and a clip tip part, respectively, the securing ring is mounted on the first concave part, and is sliding-moved from a mounting position of a first concave part with an external force to be mounted on a second concave part, thereby, said clip is used as a treating equipment for an endoscope of closing a clipping part at a tip of the clip body.

Also, the present invention provides a clipping equipment for a biological tissue equipped with an outer tube which can be inserted into a biological cavity, an operating member freely passed through the outer tube, an operating wire freely passed through the operating member, and a self-opening holder which can be opened and closed by the action of the operating member attached to a tip of the operating wire.

Also, the present invention provides a clip holder having one or two or more clip accommodating grooves for accommodating a clip comprising a self-opening clip body having a clipping part on a tip and equipped with a twin-arm part extending from a basal part, and a securing ring freely moving in a tip direction which is mounted in a concave part of the basal part, in the state where said clip is sunk with its tip facing downwardly.

BEST MODE FOR CARRYING OUT THE INVENTION

In a clipping equipment for a biological tissue (hereinafter, simply also referred to as “clipping equipment”) of the present invention and a clip, a tip side refers to a biological tissue side in the use state, and a basal side refers to a side opposite to a biological tissue. A clip in an embodiment of the present invention will be explained by referring toFIG. 1toFIG. 3. As shown inFIG. 1andFIG. 2, a clip10of the present example comprises a clip body1obtained by bending an elongate metal plate spring at a central part, and a cylindrical securing ring2. A clip body1comprises clipping parts3,3for clipping a biological tissue on a tip, a basal part4exhibiting a generally U-shaped cross section, and twin-arm parts11,11having self-opening property on a tip which extend from a basal part4. Since a metal plate spring constituting a clip body is movably inserted in a cavity of an operating member described later, a width size w thereof is restricted.

A clip body1has a first concave part5on a basal part4, and second concaves6,6between a first concave part5and a clip tip part, respectively, and a securing ring2is mounted on a first concave part5. As a site for mounting a first concave part5in a basal part, such a position is preferable that a space in which a tip of a holder8can be hung on a generally U-shaped cross-sectional part41is possessed, and opening of a clip tip in the opened state cannot be narrowed. In addition, a site for mounting a second concave part6is not particularly limited as far as it is between a first concave part5and a clip tip part, and clipping parts3,3of a clip tip are tightly abutted thereagainst. In the present example, by providing a plate width ramp69on a tip side of a second concave part6, and making a basal side from a ramp69a concave part, when a securing ring2is sliding-moved from a mounting position in a first concave part5with an external force, it is assuredly mounted in a second concave part6. It is preferable that a concave degree of a second concave part6of a clip body is larger than a concave degree of a first concave part5in that a securing ring3can be ensured. In addition, in clipping parts3,3at a clip tip, it is preferable that a tip part of a twin-arm part is bent inwardly and, at the same time, an irregular part is provided on its abutting surface in that a biological tissue can be tightly clipped.

In a clip10, a holder3on a tip is usually opened as shown inFIG. 1and, in this state, a securing ring2is mounted on a first concave part5of a basal part4. Since a cavity part of a securing ring2is hung on a recess part, a securing ring2mounted in a first concave part5is not naturally moved forwardly and backwardly as far as an external force is exerted, and is not slipped on a tip side, not narrowing an opening width of a clipping part3. Examples of a material for a clip include stainless steel, and titanium. In addition, a length of an arm part of a clip is not particularly limited, but is preferably 2.0 to 6.0 mm, particularly preferably 3.0 to 5.0 mm. When the length is within the aforementioned range, particularly, holding property of a clip is excellent.

Then, a method of clipping a biological tissue with a clip10will be explained. First, a pair of self-opening arm-like holders8which is attached to a tip of an operating wire7of a clipping equipment are hung on an internal side of a generally U-shaped cross sectional part41of a basal part4of a clip1. Then, when an operating wire7which is in a cavity of an operating member9and can be moved forwardly and backwardly is pulled, holders8are pulled into a cavity of an operating member9, and a securing ring2is abutted against a tip91of an operating member9. By further pulling an operating wire7, a twin-arm part11of an clip body is gradually pulled into a cavity of a securing ring2from a basal part side of a clip and, when pulled until a position of a second concave part6, a step69and a securing ring2are abutted, thereby, a securing ring2is stopped, clipping parts3,3at a tip of a clip body1are abutted into the state where a biological tissue (not shown) is clipped (FIG. 2). Then, when an operating wire7is pushed in a direction opposite to pulling of an operating wire7, that is, forwardly, a self-opening holder8is automatically come out from a basal part4of a clip. On the other hand, since a securing ring2is fixed firm in a recess part of a second concave part6, a clip body1in the closed state can assuredly clip a biological tissue to be clipped regardless of a size thereof, the tissue is not come out therefrom, and the state where a biological tissue is clipped can be maintained over a long period of time.

As a material for a clip body1, a metal such as stainless steel and a titanium alloy, and a plastic such as an ABS resin, a rigid vinyl chloride resin, polyamide and polyethylene are preferable in that they are not corroded in a cavity, particularly, in stomach in which a digestion enzyme is secreted. In addition, a material rich in elasticity is preferable in that, upon clipping of a biological tissue, a clipping part3at a clip tip is brought into the closed state from the opened state, and is it necessary to retain the closed state for a long period of time. In addition, a material for a securing ring is not particularly limited, but the ring is used together with a clip body1, and examples of the material include the same material as that of a clip body1. Specifically, a plastic such as fluorine resin, polyamine, and a silicone resin, and a metal such as stainless steel, and a titanium alloy are preferable.

According to a clip10of the present embodiment example, a biological tissue such as a lesion can be assuredly clipped over a long period of time.

A clipping equipment for a biological tissues in the first embodiment of the present invention will be explained by referring toFIG. 4toFIG. 10. A clipping equipment20for a biological tissue in an embodiment of the present example is equipped with an outer tube21which can be inserted into a biological cavity, an operating member22freely passed through the outer tube21, an operating wire23freely passed though the opening member22, a self-opening holder24which can be opened and closed by the action of the operating member attached to a tip of the operating wire23, and a self-opening clip10ahaving a clipping member for clipping a biological tissue which is attached to a tip of the holder24in a detachable manner by opening/closing the holder. For example, a basal part of an operating wire23is connected to a handle (not shown).

In a clipping equipment20for a biological tissue, a material for an operating member22is not particularly limited, but examples include a thermoplastic resin such as polyether ether ketone, polyamide, and polyimide, and a thin metal coil. A thermoplastic resin is preferable in that it can assuredly transmit movement of an operating handle to a tip side, and a thin metal coil is preferable in that although a gap is formed by bending or pulling, bending property and rigidity are excellent. An external diameter of an operating member22is not particularly limited, but is preferably 1.7 to 2.7 mm, particularly preferably 1.9 to 2.3 mm.

An operating wire23has a holder24fixed at a tip, and has a connecting part25having a slightly larger diameter that of a wire body which is equipped with a step26. In addition, at a position apart from a tip of an operating member22to a basal side by a stroke of an operating member, and on an internal wall of an operating member22, a stopper27through which an operating wire body can inserted and which is abutted against a step26is attached, preventing excessive protrusion of an operating member22, and preventing a holder24from excessively entering an operating member22. A material for an operating wire23is not particularly limited, but a material, a whole or a part of which has flexibility, is preferable. Specific examples include a metal wire such as stainless steel, and carbon steel, and a resin fiber such as polyamide, polyether, and ultra high molecular weight polyethylene.

An outer tube21is a hollow continuous flexible member. An internal diameter of an external casing21is not particularly limited, but is preferably 1.8 to 2.8 mm, particularly preferably 2.0 to 2.4 mm. When an internal diameter is within the aforementioned range, operating property is particularly excellent. In addition, a length of an external casing21is not particularly limited, but is preferably 1,500 to 3,000 mm, particularly preferably 1,600 to 2,300 mm. When the length is within the aforementioned range, operating property in an endoscope is particularly excellent. A material for an external case21is not particularly limited, but examples include a fluorine resin such as polytetrafluoroethylene (PTFE), and a tetrafluoroethylene-hexafluoropropylene copolymer resin (FEP).

In a clipping equipment20for a biological tissue, a clip10ais not particularly limited as far as it is equipped with a self-opening twin-arm part11a, and a securing ring12for closing a clipping part15of a twin-arm part11aas shown inFIG. 4, but a clip10shown inFIG. 1andFIG. 2is preferable.

A method of mounting a clip10ain a clipping equipment20for a biological tissue by the aforementioned construction will be explained. For example, in the state ofFIG. 4, an operating wire23is fixed at an operating handle and, by pulling an operating handle, an operating member22is moved on a holder24side in a direction of an axis line of an operating wire23. Thereby, a holder24consisting of a pair of arm parts enters a basal side while contacting with an internal circumferential surface of an operating member22, therefore, is gradually being closed. And, a tip hook28of an operating member22is closed, clipping a basal part14of a clip10ato retain a clip10a. Further, by pulling an operating handle, a securing ring12is abutted against a tip of an operating member22, and then a securing ring12is abutted against a step13which is between both arm parts of a clip10a, closing clipping parts15,15of a clip (FIG. 6,FIG. 9). By returning an operating member22to an original position from this state, a holder24is protruded from an operating member22, self-opening property possessed by a holder24makes a pair of arm parts in the opened state, and a clip10awhile it is opened can be detached.

According to a clipping equipment20for a biological tissue, complicated operating is not necessary in mounting or detaching a clip. In addition, when a clip10ais retained by a holder24, even if an operating member22is moved slightly, since a holder24is still accommodated in a cavity of an operating member22, and tip hooks28are overlaid each other, a clip10ais not easily fallen. In addition, even when a gap between tip hooks28is slightly opened, since a plate of a U-shaped cross section41of a basal part4of a clip10ahas an extent of a width, a clip10ais not fallen from a holder24.

In a clipping equipment20for a biological tissue, a shape of a holder24is not limited to the aforementioned generally V-letter shape, but for example, a generally U-letter shape24aas shown inFIG. 10suffices. By curving an arm part of a holder24a, a load applied to a connecting part25accompanied with shape change can be dispersed, spring characteristic is improved and, further, a tip part can be closed more rapidly as compared with a linear-like state. As a curved shape, any shape can be adopted in view of a time of opening and closing motion of a twin-arm part, and spring characteristic.

In addition, a method of operating member22and an operating wire23is not limited to the aforementioned method, but examples include a method of fixing an operating wire23, and moving an operating member22, and a method of moving both of an operating wire23and an operating member22.

According to a clipping equipment20for a biological tissue, since complicating procedure such as mounting and detachment of a clip is not necessary, the equipment is extremely useful as a clipping equipment for a biological tissue which is used in marking for making clear a region where treatment such as ligation and excision of a bleeding site of a biological tissue.

Then, a clipping equipment for a biological tissue in a second embodiment will be explained by referring toFIG. 11toFIG. 23. InFIG. 12, description of a sliding cylinder211ofFIG. 11is omitted. In a clipping equipment30for a biological tissue of the present example, the same symbol is added to the same component as that of the clipping equipment20for a biological tissue in the first embodiment example, explanation thereof is omitted, and different points will be mainly explained. That is, in a clipping equipment30for a biological tissue, a different point from a clip equipment20for a biological tissue is in that the equipment further has a handle51for controlling an operating member, and a first forcing mechanism for forwarding a handle51and, at the same time, stopping forwarding of a handle51, a retaining mechanism for retaining a stoppage position of a handle51once, a second forcing mechanism for further forwarding from a stoppage position of a handle51and, at the same time, stopping forwarding of a handle, and a returning mechanism by which a handle51is automatically returned to a position before first forcing are provided. That is, a clipping equipment30consists of an external casing21, a hollow sliding cylinder211which is connected to an external casing21on a tip side, and provided with a connecting flange213on a basal side, an equipment body part61equipped with a main chamber in which a tip side part is fitted into a cavity of a sliding cylinder211, a stopping means situated on a tip side which is mounted in a main chamber of an equipment body part61in the fixed state, a position retaining means64which is mounted in a main chamber adjacent to a stopping means63on a basal side in the fixed state, a handle51which is inserted into an equipment body part61from a basal side, and a bar-like member71in which one end on a basal side is abutted against a back of a substrate651of a rotation body65, and the other end is protruded from a tip side of an equipment body part61.

A handle51consists of a ring-like clipping part511, and a handle axis512in which one end is connected to a clipping part511and the other end is equipped with a crown-like first cam part514. A clipping part511is operated by an operator by grasping with a hand, and has such an extent of a space that a finger of an operator can be inserted. A first cam part514is a ring-like projection having 6 triangular projections in which valley parts are formed every 60 degree on an end face of a cylindrical member. A first cam part514engages with three engaging feathers653of a rotation body65which moves in a stopping means63and in a position retaining means64, and imparts a forwarding force and a rotating force to a rotation body65. In the figure, for drawing reason, there is a different form around a connecting part of a ring-like clipping part511and a handle axis512.

A position retaining means64is a cylindrical member which is fixed in a main chamber615of an equipment body part61, determines a position of accommodation of a rotation body65in the state before operation, guides forwarding of a rotation body65by first forcing operation and, at the same time, leads a rotation body to a position of initiation of second forcing. On an internal circumferential surface644, three fitting grooves641in which three plate-like feather members653of a rotation body65are fitted are formed along with a longitudinal direction. In addition, on a circumferential edge of an opening on a tip end, a cam group642equipped with 6 saw blade cross section-shaped notches645is attached. When a tip of a feather member653of a rotation body is abutted against an inclined surface of a notch645by spring power, a cam groove642imparts rotation of maximum 60 degree. An inclined surface of a notch645is formed as a descending inclination in a counterclock direction seen from a tip side.

A stopping means63is a cylindrical member which is fixed adjacent to a tip side of a position retaining means64in a main chamber of an equipment body part61, stops a entering rotation body65by first forcing operation and, at the same time, guides entrance of a rotation body65by second forcing operation. A stopping means63has three ribs631extending from a tip side to a midway in an axial direction on an internal circumferential surface (length of symbol m ofFIG. 22). Three ribs631are formed at an interval of 120 degree, and one rib is formed at a position at 50 degree counterclockwisely relative to a vertical axis seen from a tip side. A stopping means63is such that a tip opening is abutted against a wall of a main chamber in the state where it is disposed in a main chamber of an equipment body part61. For this reason, a rotation body65is not protruded from a stopping means63in a tip direction. A length l of a stopping means63is a forwarding stroke of a rotation body65.

A rotation body65is fitted with a first cam part514at a tip of a handle axis, and is forwarded, retreated or rotated in a position retaining means64and a stopping means63to transmit an operating force to a bar-like member71. A rotation body65has a substrate651positioned at a tip side which has notches654at a 120 degree pitch, and a second cam part654having one end on a basal side thereof of a sharp cross section656shape with a plate-like feather member653which extends in an axial direction, at the same time, is attached at a 120 degree pitch between notches654, on a substrate651. In addition, the body has an engaging pore655with which a tip part731of a bar-like member71is engaged, on a center of a back of a substrate651.

A bar-like member71has a holder24attached at a tip, and is equipped with an operating wire23in which a basal end is fixed at a fixing ring part73, an operating member22having a cavity in which an operating wire23is inserted, and having a regulating part741on a basal end, and a sliding short casing75in which a window part751is formed on an external circumferential surface of a cylindrical casing abutting with a regulating part741on a basal side. A basal part751of a sliding short casing75is engaged with an engaging pore655on a back of a substrate651of a rotating body. A fixing ring part73is fixed on a tip side slightly from a main chamber of an equipment body part61, and is not interlocked with operation of a handle. A fixing ring part73of an operating wire23is slidably fitted in a window part751of a sliding short casing75. An operating member22is forwarded against spring power of a spring74via a sliding short casing75by forwarding of a rotation body65(forwarding of a handle51) and, when a rotation body65is retreated by spring power of a spring74, the member is retreated interlocking therewith. In addition, since an operating wire23is freely inserted into an operating member22, and a connecting part733on a basal side is slided in a window part751of a sliding short casing75, this is not interlocked with operation of a handle51(movement of an operating member22).

An interior of an equipment body part61has, in an order from a tip side, a tip opening616in which an operating member22comes in and out, a chamber614for accommodating a spring74, a fixing part617at which a fixing ring part73of a bar-like member is fixed, a main chamber615in which a stopping means63and a position retaining means64are accommodated, and an inserting port616in which a tip of a handle axis is inserted. In an equipment body part61, a first flange part611, and a second flange part612are attached to a cylindrical body from a basal side, to enhance operating property.

A sliding cylinder211is a member for operating forwarding and retreating of a hollow external casing21, and is a cylindrical entity which is fitted at a tip part of an equipment body part611. A tip side is connected to a hollow external casing21which is inserted into a biological cavity, and a fixing flange213having a convex part (not shown) fitting in a concave part613of an equipment body part is provided on a basal side. An engagement releasing means214for releasing engagement between a slide cylinder211and an equipment body61is attached to a fixing flange213. An operating member22is inserted into an external casing21. And, a sliding cylinder211mounted on an equipment body part61is such that, when operation of pulling a handle51in the state where engagement with an equipment body part61is released, or forcing a sliding cylinder21therein is performed, an external casing21is forwarded to an operating member22. Thereby, a twin-arm part of a clip10ais closed, and can be transiently accommodated in an external casing21in the state where a clip10ais closed. Thereby, when an external casing21is inserted into an endoscope, since a clip10ais accommodated in an external casing21, a forceps pore of an endoscope is not damaged.

Then, a method of operating a clipping equipment30of a second embodiment example will be explained below by referring to mainlyFIG. 22andFIG. 23. A method of operating a clipping equipment30comprises first forcing operation, retaining step, second forcing operation and returning step. In first forcing operation, when a handle51is pushed, a first cam part514at a tip of a handle and a second cam part654of a rotation body65are abutted (FIG. 22(a) andFIG. 23(a)). In this case, a first cam part514and a second cam part654are arranged so that mutual mountain-like top parts of cam parts are slightly slipped. Therefore, a mountain-like top part515of a first cam part514at a tip of a handle is forwarded while abutting against a mountain-like inclination of a second cam part654of a rotation body. And, a rotation body65is forwarded from a position retaining means64to a stopping means63. When a rotation body65enters a stopping means63, a first cam part514and a second cam part654are completely engaged, and a rotation body65is rotated from an original position by 30 degree counterclockwisely (first rotation). In this state, since a substrate651of a rotation body is in a relation that the substrate is abutted with a rib631of a stopping means63, a rotation body65is moved by a stroke n, runs against an end face of a rib631, and is stopped (FIG. 22(b) andFIG. 23(b)). By first forcing operation, an operating member22of a bar-like member71which is interlocked with movement of a rotation65is forwarded, a holder24is pulled into an operation member22to close a tip of a holder24, making a holder24retain a clip10a(FIG. 5).

In a retaining step, after first forcing operation, when a hand is released from a handle51, a rotation body65is retreated by an elastic force of a spring74, and a second cam part of a rotation body65and a cam groove642of a position retaining means are engaged. Thereupon, a tip of a second cam part of a rotation part65is rotated from an original position by 60 degree counterclockwisely along with inclination of saw blade-like cam groove642(second rotation), and is stopped in a valley part of a cam groove642(FIG. 22(c) andFIG. 23(c)). Thereby, the state where an opened clip10ais retained at a tip of a holder24can be maintained. In addition, since an opening degree of a clip10ais constant, position adjustment by fine handle procedure becomes unnecessary.

In second forcing operation, when a handle51is pushed from the retention state, a first cam part514of a handle axis and a second cam part of a rotation body are engaged, and a rotation body65is further rotated from an original position by 90 degree (third position). In this state, a notch part654of a rotation part65and a rib631of a stopping means63are in a fitting positional relationship. In this state, when a handle51is forced, a rotation body65is forwarded to a tip of a stopping means63(FIG. 22(d) andFIG. 23(d)). By second forcing operation, an operating member22of a bar-like member71which is interlocked with movement of a rotation body65is further forwarded by a stroke m, closing a clipping part15of a clip10a(FIG. 6).

In a returning step, after second forcing operation, when a hand is released from a handle51, an operating member22is returned by elastic action of a spring74and, interlocking therewith, fitting between a rotation body65, a feather member653, and a rib631of a stopping means63is released, a tip of a rotation body65comes to a spiral cam groove642, is further moved along with its inclination, and is stopped at a valley part, rotating from an original position by 120 degree counterclockwisely (forth rotation). In this state, a feather member653of a rotation body65and a groove641of a position retaining means64are positioned so that they are fitted. For this reason, a rotation body65is automatically returned to an original position. Since by a returning step, an operating member22is returned to an original position, a tip of a self-opening holder is opened, and a clip10ais detached from a holder24. On the other hand, a clip of10ais still closed, and mounting of a biological tissue on a clip10ais completed.

In a clipping equipment30of a second embodiment example, an operating method is not limited to the aforementioned method of fixing an operating wire23, and moving an operating member22by seeing relatively, but by reversing a position of a spring, and directions of a rotation body, a stopping means, and a position retaining means, an operation member may be fixed, and an operating wire may be moved. Alternatively, by changing shapes of a rotation body, a stopping means, and a position retaining means, multi-stage stoppage, and position retaining may be performed.

According to a clipping equipment30of a second embodiment example, when ligation and excision of a bleeding site of a biological tissue with an endoscope are performed, since it is not necessary to see an extent of opening of a clip with an endoscope, and fine position adjustment with handle operation becomes unnecessary, a treatment time can be shortened. Alternatively, by imparting a stoppage position having a constant moving distance, a tip of an endoscope treating equipment can be put in and out by a constant amount.

Then, a clipping equipment in accordance with a third embodiment will be explained by referring toFIG. 24toFIG. 31. In a clipping equipment40in a third embodiment, the same symbol is added to the same component as that of the clipping equipment30in a second embodiment, explanation thereof will be omitted, and different points will be mainly explained. That is, a different point from a clipping equipment30in a clipping equipment40is in that a clip retaining member90is attached to an external circumferential surface of an equipment body part61near a second flange612. A clip retaining member90is a block body91, and has three of clip accommodating grooves92for accommodating a tip of a clip10downwardly in the sunk state, and generally cross grooves94consisting of guide grooves93which run straight through a center of an accommodating group92, in a direction orthogonal with an accommodating groove92. In addition, an engaging groove94which engages with a mounting equipment80is formed on a back of a block body91. By closing one end of an engaging groove94to be a wall, positioning becomes easy. That is, when a plate-like engaging piece81of a mounting equipment is completely engaged with an engaging groove94, a clip retaining member90is situated approximately at a center of an equipment body part61.

A clip accommodating groove92is slightly larger than a plate width of a twin-arm part11, and is slightly wider from a deepest part towards a surface. A depth of a clip accommodating groove92is such a depth that a basal part is slightly seen in the state where a clip10is accommodated, and a groove length of clip accommodating groove92is slightly smaller than a width by which a clip10is opened in the natural state. Thereby, upon accommodation of a clip10in an accommodating groove92, since a twin-arm part is slightly closed, stable accommodation is possible. A shape of a guide groove93is not particularly limited, but in the present example, by adopting an alloy-shaped groove when seen in a plane surface, a tip hook28of a holder24is easily guided to a generally U-shaped part41of a basal part of a clip. A guide groove93colored with a light emitting paint is preferable in that a guide groove93can be recognized even in a dark endoscope chamber. The number of clip accommodating grooves92which are formed into a block body91is 1, 2 or 4 or more in addition to the aforementioned3. A material for a clip retaining member90is not particularly limited, but when a transparent material is used, this is preferable in that weather a clip10is accommodated or not can be observed from the outside. Examples of a transparent material include a resin material such as acrylonitrile butadiene styrene resin (ABS resin), polyethylene, polystyrene, polycarbonate, and acryl resin. When a clip retaining member90is accommodated in a sterilized bag (not shown) in the state where a clip10is accommodated in an accommodating groove92, this is preferable in that it is not necessary to perform sterilization treatment every operation, and operating property is excellent.

Amounting equipment80is an adapter for attaching a clip holding member90to a cylindrical body of an equipment body part61. A mounting equipment80consists of a ring part82which is mounted on a equipment body part61, and a plate-like engaging piece82which engages with an engaging groove94of a clip holding member90having a jaw part82provided above a ring part82.

Then, a method of performing hemostasis using a clipping equipment40will be explained by referring toFIG. 28toFIG. 31. InFIG. 28, description of a flange213of a sliding cylinder211is omitted. First, a clip holding member90is removed from a sterilized bag in the state where a clip10is accommodated in an accommodating groove92, and is fixed to an equipment body part61. While a tip part of an external casing21is grasped by a hand, a tip of a holder24is pushed against a guide groove93of a clip holding member90. In this case, since a hand is not directly contacted with a clip10, there is no fear of pollution.

Then, when first forcing operation is performed by pushing a handle51, an operating member22is forwarded, a tip of holder24provided at a tip of an operating wire23is closed, and a basal part4of a clip10is held (FIG. 28,FIG. 29). This operation can be simply operated only by grasping a handle51by one hand, and grasping an outer tube21by the other hand. In addition, by simple operation of forcing a tip of a holder24into a guide groove93, a clip10can be attached to a holder24. At a tip side of an operating member22, a ring part29abutting against a securing ring2is provided. An external diameter of a ring part29is approximately the same as an external diameter of a securing ring2, and a securing ring2can be forwarded by forwarding an operating member22.

In this state, engagement between an equipment body part61and a sliding cylinder211is released, and a handle51is pulled towards a basal side. Thereby, an operating member22is pulled towards a basal side relative to an external casing21, and a clip10is transiently accommodated in an external casing21in the state where a tip thereof is closed (FIG. 30). In this state, an external casing21is passed through an endoscope (not shown), and a whole endoscope is inserted near a bleeding site in a living body. And, while an endoscope is confirmed, an external casing21is protruded from a tip of an endoscope. Then, when a handle51is pushed into a tip side, since an operating member22is forwarded relative to an external casing21, a clip10is protruded from an external casing21, and a tip becomes in the opened state. Then, a clop10having an opened tip is pushed against an objective site. And, when second forcing operation is performed by further pushing a handle51, an operating member22is forwarded to push a securing ring2of a clip towards a tip side. Thereby, a securing ring2is engaged with a second concave part6of a clip10, to clip an objective site of a living body. Since a securing ring2which has been pushed out by an operating member22is engaged with a second concave part6, the closed state of a clip is maintained. After a clip10is closed, when a hand is released from a handle51, a handle51is returned to an original position by a returning mechanism. Thereupon, since an operating member22is also retreated, a holder24is opened, and a closed clip10can be detached from a holder24(FIG. 31). And, while a clip10is dwelled in a body, a holder24together with an endoscope is extracted from a body. When a site clipped with a clip10is necrotized, a clip10is naturally detached, and is excreted from a body.

Then, a variation example of a clip holding member90will be explained by referring toFIG. 32toFIG. 34. In a clip holding member90a, the same symbol is added to the same component as that of a clip holding member90, explanation thereof will be omitted, and different points will be mainly explained. That is, in a clip holding member90a, a different point from a clip holding member90is a point in that the number of general cross grooves is one, a point in that a guide groove93ais an inclination which runs straight passing through a center of an accommodating groove and descends towards a center, a depth at a central part of a guide groove is such that the central part is above a securing ring2in the state where a clip10is accommodated, and the holder is hung on a generally U-shaped basal part of the clip, and a point in that mounting is not on an external circumferential surface of an equipment body part61, but on a separate member from a clipping equipment. Examples of a form of a guide groove93include a fan shape in addition to the aforementioned alloy shape and rectangular shape when seen on a plane surface.

Then, a method of removing a clip10accommodated in a clip holding member90awill be explained.FIG. 33is a cross-sectional view ofFIG. 32, andFIG. 34is a view showing the state where a holder24is closed inFIG. 33. A tip of a holder24is pushed against a guide groove93aof a clip holding member90aon which a clip10is mounted. In this state, by moving an operating member22to a clip holding member90aside, the state where a clip10is held by a holder24is obtained (FIG. 34). Then, a clip10is removed from a clip holding member90a, and mounting of a clip10on a clipping equipment is completed.

According to a clipping equipment40of a third embodiment example, the same operation as that of a clipping equipment30of a second embodiment example is performed and, additionally, by simple operation of grasping a handle51by one hand, grasping an external casing21by the other hand, and forcing a tip of a holder24into a guide groove93, a clip10can be attached to a holder24. For this reason, even an operator who is not familiar with this operation can perform clip mounting operation simply and efficiently.

INDUSTRIAL APPLICABILITY

The clip and the clipping equipment of the present invention are extremely useful as a treating equipment which is used in ligating a bleeding site of a biological tissue, stitching a laceration, and marking in excision of a mucosal tissue with an endoscope.