JP5219855B2 - Endoscopic suture device - Google Patents

Description

  The present invention relates to an endoscopic suturing device.

  When surgery or treatment in the body is performed using an endoscope without performing laparotomy or the like, it is necessary to suture an incision site or a perforation site through a suture instrument through a treatment instrument insertion channel of the endoscope. There is a case.

  In view of this, there has conventionally been an endoscope suturing device in which a puncture portion is provided on the outer periphery of a guide sheath and a T-bar to which a suture is attached is disposed in the puncture portion. At the time of suturing treatment, the puncture portion is pierced into the living body wall, the T-bar is left outside the living body wall, and a pair of suture threads protruding from the living body wall are tightened with an anchor member or the like (for example, Patent Documents) 1, 2).

  In addition, there are also ones in which sutures are sequentially engaged with a plurality of anchor members having pointed tips, they are arranged in a guide sheath, and the anchor members are sequentially inserted into a living body wall and sutured (for example, patents) References 3, 4).

JP 2004-358046 A JP2007-185495 Special table 2000-516513 Special table 2005-514150

  However, none of the conventional endoscopic suturing devices as described above are difficult to operate smoothly because the arrangement and movement of the T-bar, anchor member, etc. in the guide sheath are not stable. In some cases, it takes a long time to increase the burden on the operator and the patient, and the suture thread may become entangled and the suture treatment must be repeated.

  The present invention provides an endoscopic suturing device that is stable in the arrangement and operation of each member in the apparatus and that can operate smoothly and reliably and easily in a short time using an endoscope. The purpose is to provide.

  In order to achieve the above object, an endoscopic suturing device according to the present invention includes a guide sheath in which a slit with an open end is formed in a portion on the tip side straight in a direction parallel to the axis, and inserted into the guide sheath. It is attached to the placed suture thread and the distal end of the suture thread, and is squeezed inside the guide sheath while being slidably engaged with the slit. A retaining member that is wider than the diameter, and is disposed in the guide sheath in a state of being slidably engaged with the slit at a position rearward of the retaining member. It expands to a size that does not return into the guide sheath due to elasticity, and can slide and move from the proximal side to the distal side with respect to the suture thread, but movement from the distal side to the proximal side is restricted. A fixing member that engages with the clamped state, and a tip that is formed into a sharp needle tip and is slidably fitted onto the outer surface of the guide sheath, for propelling the retaining member and the fixing member toward the tip of the guide sheath A puncture cylinder provided with a propulsion unit is provided.

  In addition, the retaining member may be formed in a shape in which a plurality of blade pieces gradually expanding in the radial direction as they go rearward are connected to one at the distal end side. Further, a slit engaging protrusion that slidably engages with a slit of the guide sheath may be formed at a protruding end portion of at least one blade piece of the retaining member, and the puncture cylinder is engaged in the slit of the guide sheath. In combination, a retaining member propulsion projection that abuts against the slit engaging projection of the retaining member from the rear may be formed, and the retaining member promotion projection may constitute a propulsion portion. With such a configuration, a stable and smooth operation can be obtained.

  A positioning member engagement hole is formed in the guide sheath for positioning the retaining member, and the projecting end of at least one blade piece of the retaining member is detachably engaged with the retaining member positioning hole. A protrusion may be formed. Thereby, the arrangement of the retaining member in the apparatus becomes stable.

  In addition, the fixing member may be formed in a shape in which a plurality of blade pieces gradually expanding in the radial direction as they go forward are connected together on the rear end side, and at least one blade of the fixing member A slit engaging projection that is slidably engaged with a slit of the guide sheath may be formed on the protruding end of the piece.

  The puncture cylinder is formed with a fixing member propulsion protrusion that engages in the slit of the guide sheath and abuts against the slit engaging protrusion of the fixing member from the rear, and the fixing member propulsion protrusion constitutes the propulsion portion. Also good. With such a configuration, a stable and smooth operation can be obtained.

  In addition, a fixing member positioning hole for positioning the fixing member is formed in the guide sheath, and a positioning hole engaging with the protruding end portion of at least one blade piece of the fixing member is detachably engaged with the fixing member positioning hole. A protrusion may be formed. Thereby, the arrangement of the fixing members in the apparatus becomes stable. In a state where no force is applied from the guide sheath and the puncture tube body, the fixing member may be provided in a state in which the suture is elastically sandwiched at the rear end portion.

  Also, a puncture tube body advancing / retreating operation unit for advancing and retracting the puncture tube body in the axial direction to an operation unit connected to the proximal end of the guide sheath, and a suture pulling operation capable of pulling the suture to the proximal end side May be provided.

  Furthermore, a second retaining member attached to the suture at a position rearward of the fixing member is slidably engaged with the slit of the guide sheath, and a second fixing member that engages with the suture at a rearward position is provided. You may be slidably engaged with the slit of a guide sheath. Thereby, the suturing treatment can be performed smoothly.

  In addition, a retaining tube having an outer diameter larger than the diameter of the suture may be engaged with the suture at a position rearward of the second fixing member. Thereby, it is possible to smoothly move to the next suturing procedure.

  According to the present invention, the retaining member and the fixing member slide along the slit formed in the guide sheath, so that the arrangement and operation of each member in the apparatus can be stabilized and operate smoothly, and the guide sheath On the other hand, since the suturing can be performed only by the operation of advancing and retracting the puncture cylinder and the operation of pulling the suture from the rear, the transendoscopic suturing treatment can be performed easily and reliably in a short time.

It is a compound sectional view (partial enlarged view of Drawing 2) of the side and plane of the tip part of the suture instrument for endoscopes concerning the example of the present invention. It is a compound sectional view of a side and a plane of a tip portion of an endoscopic suture device according to an embodiment of the present invention. It is III-III sectional drawing in FIG. 1 of the Example of this invention. It is IV-IV sectional drawing in FIG. 1 of the Example of this invention. It is VV sectional drawing in FIG. 1 of the Example of this invention. It is a disassembled perspective view of the distal end portion of the guide sheath and puncture cylinder of the endoscope suturing device according to the embodiment of the present invention. FIG. 6 is a side view of the endoscope suture instrument according to the embodiment of the present invention in a state where the retaining member and the fixing member are respectively narrowed. It is a perspective view in the state where the securing member and the fixing member of the suture instrument for endoscopes according to the embodiment of the present invention are respectively narrowed. It is a side view of the state in which the retaining member and the fixing member of the endoscopic suturing device according to the embodiment of the present invention are spread by their own elasticity. It is a perspective view of the state where the retaining member and the fixing member of the endoscopic suturing device according to the embodiment of the present invention are spread by their own elasticity. It is side surface schematic sectional drawing of the operation part of the suture instrument for endoscopes which concerns on the Example of this invention. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is composite sectional drawing which shows the use condition of the suture instrument for endoscopes which concerns on the Example of this invention in order. It is a perspective view of the modification of the securing member used for the suture instrument for endoscopes which concerns on the Example of this invention. It is a perspective view of the other modification of the retaining member used for the suture instrument for endoscopes which concerns on the Example of this invention. It is a perspective view which shows an example of the retaining tube used for the suture instrument for endoscopes which concerns on the Example of this invention.

Embodiments of the present invention will be described below with reference to the drawings.
2 is a combined sectional view of the side and the plane of the suture instrument for endoscope, FIG. 1 is a partially enlarged view thereof, the upper half of each figure is a side sectional view, and the lower half is a planar sectional view. . However, only the side sectional view of the tip 2a portion of the puncture cylinder 2 is shown. 3, 4 and 5 are a sectional view taken along line III-III, a sectional view taken along line IV-IV and a sectional view taken along line VV in FIG.

  In the figure, reference numeral 1 denotes a flexible guide sheath that is inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown), and has a circular cross-sectional shape such as a PEEK (polyether ether ketone) resin tube or a polyamide resin. It is formed of a tube or the like.

  However, when the endoscope suturing device is for a rigid endoscope, the guide sheath 1 may be an inflexible stainless steel pipe or the like. The diameter of the guide sheath 1 is, for example, about 2 to 3 mm, and the length is, for example, about 0.5 to 1.5 m. The suture thread 3 is inserted through the entire length of the axial position of the guide sheath 1.

  As shown in FIG. 6 which is an exploded perspective view of a portion of the guide sheath 1 on the distal end side (for example, in a range of several centimeters to several tens of centimeters from the distal end), a slit 4 having a constant width is formed on the axis. It is formed straight in the parallel direction. Two slits 4 are provided in parallel at, for example, a 180 ° symmetrical position of the guide sheath 1, and each tip is opened at the tip of the guide sheath 1.

  As illustrated in FIG. 6, the guide sheath 1 is formed with a retaining member positioning hole 5 for positioning a retaining member 7 to be described later in a direction that is 90 ° out of phase with the slit 4. As shown in FIG. 3 and the like, the two retaining member positioning holes 5 are formed at 180 ° symmetrical positions, but at least one may be formed.

  In addition, a fixing member positioning hole 6 for positioning a fixing member 8 to be described later is formed at a position behind the retaining member positioning hole 5 at a predetermined interval in the same phase as the retaining member positioning hole 5. Has been. As shown in FIG. 5 and the like, two fixing member positioning holes 6 are formed at 180 ° symmetrical positions, but it is sufficient that at least one fixing member positioning hole 6 is formed.

  The retaining member positioning hole 5 and the fixing member positioning hole 6 have the same shape and the same size. As shown in FIG. 2, each of the plurality of sets of holes 5 and 6 is arranged at a constant interval. ing.

  As shown in FIGS. 1 and 2, on the outer surface of the guide sheath 1, an elongated cylindrical puncture cylinder 2 made of the same material as the guide sheath 1 or a material of higher hardness is advanced and retracted in the axial direction. Freely fitted. The tip 2a of the puncture tube 2 is formed in a sharp needle tip shape.

  On the inner peripheral portion of the puncture tube body 2, a retaining member propelling protrusion 27 and a fixing member propelling protrusion 28 (propulsion portion) for propelling the retaining member 7 and the fixing member 8 toward the distal end of the guide sheath 1 are provided in the slit 4. And projecting inwardly in a state of being slidably engaged. The rear end surfaces of the retaining member propelling protrusions 27 and the fixing member propelling protrusions 28 are inclined surfaces.

  As shown in FIG. 6 and FIG. 4 and the like, the retaining member propelling protrusions 27 and the fixing member propelling protrusions 28 are also formed in two at 180 ° symmetrical positions at positions corresponding to the slits 4 of the guide sheath 1. , At least one of each may be formed.

  The retaining member propelling protrusions 27 and the fixing member propelling protrusions 28 have the same shape and the same size, and as shown in FIG. 2, each of the plurality of sets of protrusions 27, 28 has the retaining member positioning hole 5. And the fixed member positioning holes 6 are arranged at the same fixed intervals.

  As shown in FIG. 1, a retaining member 7 that is left on the back surface of the living body wall and functions as a retaining member for the suture 3 is fixedly attached to the distal end portion of the suture 3. ing.

  At a position slightly behind the retaining member 7, a fixing member 8 that is pressed against the living body wall from the surface side during the suturing operation and is fixed to the retaining member 7 so as to sandwich the living body wall is a suture thread. 3 is slidably engaged.

  FIGS. 7 and 8 are a side view and a perspective view of the retaining member 7 and the fixing member 8 housed in the guide sheath 1, and FIGS. 9 and 10 illustrate the retaining member 7 and the fixing member 8 outside the guide sheath 1. They are a side view and a perspective view in a state where the external force is no longer applied due to the movement.

  As shown in FIGS. 9 and 10, in the natural state where no external force is applied, the retaining member 7 connects a plurality of blade pieces 70, which gradually spread in the radial direction toward the rear, to one at the tip side. It is formed in the shape.

  For example, four blade pieces 70 are provided at intervals of 90 °. Then, slit engaging projections 7a that slidably engage with the slits 4 from the inside of the guide sheath 1 are formed to protrude from the projecting end portions of the two blade pieces 70 that are positioned at an interval of 180 ° among the four. (See also FIGS. 1 and 3). However, at least one slit engaging protrusion 7a may be provided.

  Further, as shown in FIG. 9 and FIG. 10, a positioning hole engagement that removably engages with the retaining member positioning hole 5 from the inside of the guide sheath 1 at the protruding end portions of the remaining two blade pieces 70. A protrusion 7b is formed to protrude (see also FIG. 1, FIG. 3, etc.).

  However, it is sufficient that at least one positioning hole engaging protrusion 7b is provided, and the retaining member 7 is positioned in the guide sheath 1 by engaging the positioning hole engaging protrusion 7b with the retaining member positioning hole 5. The

  The retaining member 7 is formed entirely of a spring material, and the slit engaging projection 7a is slidably engaged with the slit 4 in the guide sheath 1 as shown in FIGS. As shown in the figure, the elastically deformed portion is placed in a constricted state. When the retaining member 7 is taken out of the guide sheath 1, as shown in FIGS. 9 and 10, the retaining member 7 is in a state of being larger than the diameter of the guide sheath 1 due to its own elasticity.

  As shown in FIGS. 7 to 10, the fixing member 8 is formed in a clothespin shape in which a pair of plastic blade pieces 82 are integrally attached to a leaf spring portion 81, and its rear end portion 8e. The suture thread 3 is sandwiched between the two. The pair of blade pieces 82 is formed in a shape that gradually expands in the radial direction as it goes forward and is connected by a leaf spring portion 81 on the rear end side.

  The fixing member 8 is provided so that the suture thread 3 is clamped to some extent by the rear end portion 8e in the natural state, but in the guide sheath 1, the blade piece 82 is the inner peripheral portion of the guide sheath 1. In other words, the rear end portion 8e of the fixing member 8 is slightly widened, and the suture thread 3 is not pinched.

  When the fixing member 8 is moved out of the guide sheath 1 and no external force is applied, the rear end portion 8e of the fixing member 8 is elastically clamped by the spring force of the leaf spring portion 81 with respect to the suture thread 3. Engage with the attached state.

  As a result, the fixing member 8 can be slid from the proximal end side toward the distal end side with respect to the suture thread 3, but the rear end portion 8 e of the fixing member 8 is sewn in the movement from the distal end side to the proximal end direction. The thread 3 is cut into the regulated state.

  The blade piece 82 of the fixing member 8 is elastically deformed so as to be slightly constricted in the guide sheath 1. When the blade piece 82 is moved out of the guide sheath 1, the blade piece 82 expands so as not to return into the guide sheath 1 due to its own elasticity. .

  The fixing member 8 has a pair of second blade pieces 83 formed integrally with the leaf spring portion 81 extending obliquely forward in a direction perpendicular to the pair of blade pieces 82 in the direction around the axis. It is formed out.

  A slit engaging projection 8a that slidably engages with the slit 4 from the inside of the guide sheath 1 is formed so as to protrude obliquely rearward from the protruding end portion of each second blade piece 83 (see also FIG. 1 and the like). ). However, at least one slit engaging protrusion 8a may be provided.

  Further, a positioning hole engaging projection 8b that engages and disengages with respect to the fixing member positioning hole 6 from the inside of the guide sheath 1 protrudes from the protruding end portion of the pair of blade pieces 82 (FIGS. 1 and 2). See also 5 etc.).

  However, it is sufficient that at least one positioning hole engaging protrusion 8b is provided. When the positioning hole engaging protrusion 8b engages with the fixing member positioning hole 6, the fixing member 8 is positioned in the guide sheath 1. The

  Returning to FIG. 1, the retaining member propelling protrusion 27 that protrudes inwardly on the inner peripheral portion of the puncture tube body 2 is in contact with the slit engaging protrusion 7 a of the retaining member 7 from the rear (FIG. 4). The fixing member propelling protrusion 28 is in contact with the slit engaging protrusion 8a of the fixing member 8 from the rear (see also FIG. 5).

  Therefore, when the puncture tube body 2 moves from the rear to the front with respect to the guide sheath 1, the slit engaging projection 7a of the retaining member 7 is pushed forward by the retaining member propelling projection 27 of the puncture tube body 2, and as a result, The positioning hole engaging projection 7 b is detached from the retaining member positioning hole 5, and the retaining member 7 moves forward in the guide sheath 1. When the retaining member 7 is pushed out from the distal end of the guide sheath 1, the retaining member 7 is in a state of being larger than the diameter of the guide sheath 1 due to its own elasticity.

  Further, when the puncture cylinder 2 moves from the rear to the front with respect to the guide sheath 1, the slit engaging protrusion 8a of the fixing member 8 is pushed forward by the fixing member propulsion protrusion 28 of the puncture cylinder 2, and as a result Then, the positioning hole engaging protrusion 8 b is detached from the fixing member positioning hole 6, and the fixing member 8 moves forward in the guide sheath 1.

  When the fixing member 8 is pushed out from the distal end of the guide sheath 1, the rear end portion 8 e of the fixing member 8 elastically clamps the suture thread 3 so that the fixing member 8 cannot return into the guide sheath 1. At the same time as spreading, the suture 3 can be slid from the proximal side to the distal side, but the movement from the distal side to the proximal side is regulated.

  As shown in FIG. 2, a plurality of retaining members 7 and fixing members 8 as described above are sequentially arranged in series in the guide sheath 1 at equal intervals. That is, the second retaining member 7 ′ slidably attached to the middle portion of the suture thread 3 at a position behind the fixing member 8 is slidably engaged with the slit 4 of the guide sheath 1, and is located at a position behind the second retaining member 7 ′. A second fixing member 8 ′ slidably engaged with the suture thread 3 is provided to slidably engage with the slit 4.

  A retaining tube 9 made of, for example, a stainless steel pipe material having an outer diameter larger than the diameter of the suture thread 3 is slidably fitted to the suture thread 3 at a position behind the second fixing member 8 '. Yes. For example, as shown in FIG. 25, the retaining tube 9 is a pipe-shaped member having a C-shaped cross section having a slit 9a, and an occlusal protrusion 9b that engages with the suture thread 3 by crushing the slit 9a is formed inside. It is formed on the peripheral surface. A subsequent retaining member 7 ″ is disposed in engagement with the suture thread 3 behind the retaining tube 9.

  FIG. 11 schematically shows an example of the operation unit 10 connected to the proximal end of the guide sheath 1. Reference numeral 11 denotes an operation unit body in which the proximal end of the guide sheath 1 is fixedly connected. In addition, the working end of a puncture cylinder operation lever 13 (puncture cylinder advance / retreat operation section) that rotates about the support shaft 12 is connected to the base end of the puncture cylinder 2 via a connection pin 14.

  As a result, the puncture tube body operation lever 13 can be rotated to move the puncture tube body 2 in the axial direction relative to the guide sheath 1, and the puncture tube body operation lever 13 can be punctured by a one-stroke operation. The cylindrical body 2 is pushed forward by a distance between the retaining member propelling protrusion 27 and the fixing member propelling protrusion 28. The detailed structure around the connecting pin 14 is not shown. Reference numeral 15 denotes a return spring that acts on the puncture cylinder operating lever 13.

  The proximal end portion of the suture thread 3 is arranged to extend straight out from the proximal end opening of the guide sheath 1, and a handle 16 (suture pulling operation portion) is attached to the proximal end of the suture thread 3. As a result, the suture thread 3 can be pulled to the proximal end side by the handle 16. The operation unit 10 may have any configuration as long as an operation unit that moves the puncture tube 2 forward and backward and an operation unit that pulls the suture thread 3 are provided.

  12 to 22 sequentially show the state of the suturing treatment performed using the endoscopic suturing device of the above embodiment. Note that the hatched display is omitted for the cross section of the portion other than the living body wall 100.

  12 shows that the puncture tube body 2 of the endoscopic suture device guided through the treatment instrument insertion channel of the endoscope (not shown) is guided by the puncture tube body operation lever 13 of the operation unit 10. A state in which the living body wall 100 is punctured by being pushed forward with respect to the sheath 1 is shown. The distal end of the guide sheath 1 is just at the position of the living body wall 100, and the distal end 2 a of the puncture cylinder 2 protrudes to the back side of the living body wall 100.

  Here, as compared with the state before puncturing, the retaining member 7 and the fixing member 8 are pushed forward by the retaining member propelling protrusions 27 and the fixing member propelling protrusions 28 formed on the puncture cylinder 2, so that the retaining member positioning holes 5 and the fixing member positioning hole 6 are disengaged and moved forward with respect to the guide sheath 1 together with the puncture tube 2.

  As a result, the positioning hole engaging projection 7b of the retaining member 7 is pushed out from the distal end of the guide sheath 1, so that the retaining member 7 cannot return into the guide sheath 1, and at the same time, the positioning hole engaging projection of the fixing member 8 8 b is in a state of engaging with the retaining member positioning hole 5.

  Then, when the turning operation of the puncture cylinder operation lever 13 is loosened and the puncture cylinder operation lever 13 is returned to the initial state by the urging force of the return spring 15, as shown in FIG. In this state, the puncture cylinder 2 is retracted rearward, and the retaining member 7 is left behind the living body wall 100, and the retaining member 7 that is positioned in the free space spreads by its own elasticity. It will be in the state which cannot return to the front side of the biological body wall 100. FIG. At the same time, the slit engaging protrusion 8a of the fixing member 8 is pushed from behind by the retaining member propelling protrusion 27 that has been positioned forward.

  Next, as shown in FIG. 14, after the guide sheath 1 is retracted backward, the puncture tube body 2 is pushed forward again by the puncture tube body operation lever 13, and the fixing member 8 is moved to the distal end position of the guide sheath 1. Then, as shown in FIG. 15, the puncture tube body 2 is retracted backward. The fixing member 8 spreading outside the guide sheath 1 is caught by the tip of the guide sheath 1 and does not return into the guide sheath 1.

  Therefore, when the suture thread 3 is pulled from the operation unit 10 side, the guide sheath 1 and the puncture tube 2 are pushed forward as a relative operation and held at the distal end of the guide sheath 1 as shown in FIG. The fixing member 8 in the state of being slid forward with respect to the suture thread 3 and pressed against the surface of the living body wall 100.

  Next, as shown in FIG. 17, when the guide sheath 1 and the puncture tube body 2 are retracted backward again, the fixing member 8 cannot bite into the suture thread 3 and cannot move backward, so that the fixing member 7 is fixed. The state in which the member 8 is fixed with the living body wall 100 interposed therebetween is maintained.

  Then, as shown in FIG. 18, the puncture cylinder 2 is pierced at a position straddling the opening 101 of the living body wall 100, and the second procedure is performed in the same procedure as described above as shown in FIGS. If the retaining member 7 ′ and the second fixing member 8 ′ are fixed thereto, and the suture thread 3 is pulled from the operation unit 10 side to remove the slack, two positions across the opening 101 of the living body wall 100 are obtained. The suture thread 3 is fastened to the opening 101 so that the opening 101 is stitched.

  Therefore, as shown in FIG. 22, one suture operation is performed by cutting the suture thread 3 at a position near the second fixing member 8 ′ using an endoscopic scissors forceps or the like not shown. Complete.

  However, before the suture thread 3 is cut, the slit 9a of the retaining tube 9 is crushed by using a grasping forceps or the like (not shown), and the retaining tube 9 is fixed by engaging the occlusal protrusion 9b with the suture thread 3. This prevents the suture 3 from being pulled out to the hand side by mistake, so that the next suture is performed by the retaining member 7 and the fixing member 8 (not shown) remaining in the guide sheath 1. be able to.

  In addition, this invention is not limited to the said Example, For example, as the retaining member 7 is shown by the modification of FIG.23 and FIG.24, only two blade pieces 70 are provided, and the protrusion is at the tip. The slit engaging protrusions 7a and the positioning hole engaging protrusions 7b may be provided individually or the like.

DESCRIPTION OF SYMBOLS 1 Guide sheath 2 Puncture cylinder 2a Tip 3 Suture 4 Slit 5 Retaining member positioning hole 6 Fixing member positioning hole 7, 7 ', 7 "Retaining member 7a Slit engaging protrusion 7b Positioning hole engaging protrusion 8, 8' Fixing member 8a Slit engagement protrusion 8b Positioning hole engagement protrusion 8e Rear end 9 Retaining tube 10 Operation part 13 Puncture cylinder operation lever (puncture cylinder advance / retreat operation part)
16 Handle (Suture traction operation section)
27 Protrusion protrusion (promotion part)
28 Fixed member propulsion protrusion (promotion part)
70 feather pieces

Claims (13)

A guide sheath in which a slit with a distal end opened is formed in a portion on the distal end side straight in a direction parallel to the axis,
A suture thread inserted into the guide sheath;
It is attached to the distal end portion of the suture thread and is squeezed and arranged in the guide sheath while being slidably engaged with the slit. A retaining member that is in a greatly expanded state,
It is disposed in the guide sheath in a state of being slidably engaged with the slit by being engaged with the suture thread at a position rearward from the retaining member, and outside the guide sheath, it is placed in the guide sheath by its own elasticity. A fixing member that spreads in a size that cannot be returned and can slide and move from the proximal side to the distal side with respect to the suture, but is engaged in a state where movement from the distal side to the proximal side is restricted;
A puncture tube having a tip formed in a sharp needle tip and slidably fitted on the outer surface of the guide sheath, and having a propulsion unit for propelling the retaining member and the fixing member toward the tip of the guide sheath An endoscopic suturing device comprising: a body;   The endoscopic suturing device according to claim 1, wherein the retaining member is formed in a shape in which a plurality of blade pieces gradually expanding in the radial direction as they go rearward are connected to each other on the distal end side.   The suturing device for an endoscope according to claim 2, wherein a slit engaging projection that is slidably engaged with a slit of the guide sheath is formed at a protruding end portion of at least one blade piece of the retaining member.   The puncture cylinder is formed with a retaining member propulsion projection that engages in the slit of the guide sheath and abuts against the slit engaging projection of the retaining member from the rear, and the retaining member propulsion projection constitutes the propulsion unit. The endoscopic suturing device according to claim 3.   A positioning member positioning hole for positioning the retaining member is formed in the guide sheath, and a positioning hole that is detachably engaged with the projecting end of at least one blade piece of the retaining member in the retaining member positioning hole. The endoscopic suturing device according to claim 2, 3 or 4, wherein an engaging protrusion is formed.   6. The fixing member according to any one of claims 1 to 5, wherein the fixing member is formed in a shape in which a plurality of blade pieces gradually expanding in the radial direction as they go forward are connected together on the rear end side. Endoscopic suture device.   The suturing device for an endoscope according to claim 6, wherein a slit engaging projection that is slidably engaged with a slit of the guide sheath is formed at a protruding end portion of at least one blade piece of the fixing member.   The puncture cylinder is formed with a fixing member propulsion protrusion that engages in the slit of the guide sheath and abuts against the slit engaging protrusion of the fixing member from the rear, and the fixing member propulsion protrusion constitutes the propulsion unit. The endoscopic suturing device according to claim 7.   A fixing member positioning hole for positioning the fixing member is formed in the guide sheath, and a positioning hole that is detachably engaged with the fixing member positioning hole at a protruding end portion of at least one blade piece of the fixing member. The suture instrument for an endoscope according to claim 6, 7 or 8, wherein an engagement protrusion is formed.   The fixing member according to any one of claims 1 to 9, wherein the fixing member is provided in a state in which the suture is elastically clamped at a rear end portion when no force is applied from the guide sheath and the puncture tube body. The endoscope suturing device according to Item.   A puncture tube body advancing / retreating operation unit for advancing / retreating the puncture tube body in the axial direction to an operation unit connected to the proximal end of the guide sheath, and a suture puller capable of pulling the suture to the proximal end side The endoscopic suturing device according to any one of claims 1 to 10, further comprising an operation unit.   A second retaining member attached to the suture at a position rearward of the fixing member is slidably engaged with a slit of the guide sheath, and is engaged with the suture at a rearward position thereof. The suture instrument for an endoscope according to any one of claims 1 to 11, wherein a member is slidably engaged with a slit of the guide sheath.   The suture instrument for endoscope according to claim 12, wherein a retaining tube having an outer diameter larger than the diameter of the suture is engaged with the suture at a position rearward of the second fixing member.

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