JP7333232B2 - medical instrument - Google Patents

Description

The present invention relates to a medical treatment instrument.

2. Description of the Related Art In the treatment of tumors such as cancer, medical treatment instruments are used to perform various treatments such as maintenance of lesions, hemostasis, and cauterization. As such a treatment tool, there is one in which a thread-like object is tied to a treatment portion such as a clip provided on the distal side of the treatment tool. By moving the filamentous object in the distance direction, the operator can operate the treatment section such as opening and closing the clip. In order to make it easier for the operator to move the filament in the distance direction, it has been proposed to provide a fixing device for the operator to hold the filament on the proximal side in the distance direction.

U.S. Patent No. 6,200,400 discloses a surgical instrument configured to anchor a knotless suture between a plug and an inner wall surface of an anchor, wherein the anchor tapers from a first end to a second end of the anchor. and that the first end of the anchor has a larger diameter than the second end.

Patent document 2 has a hole member having a hole, and a shaft member that fits into the hole and sandwiches a filament between the hole and the shaft member. A medical fixation device is disclosed that is grooved for winding.

Japanese Patent No. 5323694 WO2016/104075

However, with the instrument described in Patent Document 1, the suture may come off, especially when the suture contains a slippery material such as fluororesin. Further, in order to fix the filamentous material to the device described in Patent Document 2, it is necessary to wind the filamentous material around the groove of the shaft member, so it may take time to attach the filamentous material to the fixing device. Ta. SUMMARY OF THE INVENTION Accordingly, it is an object of the present invention to provide a medical treatment instrument having a fixing device capable of efficiently fixing a filament while preventing the filament from coming off.

One embodiment of the medical treatment instrument of the present invention, which has achieved the above object, comprises an inner cylindrical body having a distal side and a proximal side; A treatment section disposed on the distal side of the cylindrical body and connected to the distal side of the filament, and a treatment section disposed on the proximal side of the inner cylindrical body and sandwiching the proximal side of the filament, and under the following conditions: The fixing device has a first fixing member having a nut portion, and a second fixing member having a bolt portion that is fitted to the nut portion and clamps a thread-like object, and has a thread-like The gist is that a knot is provided on the proximal side of the object, and the knot is arranged on the proximal side of the following contact surface in the perspective direction of the filamentous object.
[conditions]
In the fixing device, when the bolt portion is turned and advanced with respect to the nut portion in a state in which the filamentous object is not clamped, the first fixing member and the second fixing member are arranged such that the normal vector is parallel to the advancing direction of the bolt portion. Advancement is inhibited by direct or indirect contact with each other at contact surfaces having different components.

According to the above-described medical treatment instrument, the thread-like object is fixed by fitting the bolt portion of the second fixing member to the nut portion of the first fixing member while the thread-like object is arranged between the first fixing member and the second fixing member. It is possible to efficiently attach a fixing device to an object. Further, in the above medical treatment device, the knot of the filament is arranged closer to the proximal side of the filament in the distance direction than the contact surface between the first fixing member and the second fixing member when the filament is not sandwiched. ing. At this time, the portion of the filament other than the knot is strongly held between the contact surfaces, but even if the filament is pulled in the near and far directions, the knot cannot pass through the portion of the contact surface. Therefore, according to the medical treatment instrument, it is possible to prevent the filamentous material from coming off from the fixing instrument.

In the above medical treatment instrument, it is preferable that the filamentous material is made of a material containing a fluororesin.

In the medical treatment instrument described above, the second fixing member has a large diameter portion provided adjacent to the bolt portion in the forward direction of the bolt portion and having an outer diameter larger than the maximum outer diameter of the bolt portion. The fixing member is provided adjacent to the nut portion in the advancing direction of the bolt portion and has a recess for receiving the large diameter portion. is in direct or indirect contact with the distal or proximal end face of the large diameter portion of the second fixation member.

In the medical treatment instrument described above, the inner peripheral surface of the concave portion of the first fixing member directly or indirectly contacts the outer peripheral surface of the large-diameter portion of the second fixing member in a state where the fixing device does not sandwich the filamentous object. preferably.

In the above medical treatment instrument, the knot is preferably not in contact with the contact surface.

In the above medical treatment instrument, it is preferable that the knot is held between the first fixing member and the second fixing member.

In the above medical treatment instrument, it is preferable that the knot exists outside the fixing device.

In the above-described medical treatment instrument, when the bolt portion is fitted to the nut portion, the distal end of the first fixing member is arranged on the distal side of the filament in the distance direction from the distal end of the second fixing member. It is preferable that

In the above-described medical treatment device, when the bolt portion is fitted to the nut portion, the distal end of the second fixing member is arranged on the distal side of the filament in the distance direction from the distal end of the first fixing member. It is preferable that

In the above-described medical treatment instrument, the fixing device preferably has an adhesive portion where the first fixing member and the second fixing member are adhered to each other.

In the above medical treatment instrument, it is preferable that the advancing direction of the bolt portion is parallel to the far-near direction of the inner cylindrical body.

In the above medical treatment instrument, it is preferable that the first fixing member and the second fixing member are in contact with each other via the ring member on the contact surface in a state where the fixing device does not sandwich the filamentous object.

In the above medical treatment instrument, the treatment section is a clip that grips the body tissue, and the clip has two clamping base materials. Preferably, fasteners are provided that are large in diameter and axially movable.

According to the above-described medical treatment instrument, the thread-like object is fixed by fitting the bolt portion of the second fixing member to the nut portion of the first fixing member while the thread-like object is arranged between the first fixing member and the second fixing member. It is possible to efficiently attach a fixing device to an object. Further, in the above medical treatment device, the knot of the filament is arranged closer to the proximal side of the filament in the distance direction than the contact surface between the first fixing member and the second fixing member when the filament is not sandwiched. ing. At this time, the portion of the filamentous material other than the knot is strongly held between the contact surfaces, but even if the filamentous material is pulled in the far and near directions, the knot cannot pass through this contact surface portion. Therefore, according to the medical treatment instrument, it is possible to prevent the filamentous material from coming off from the fixing instrument.

1 shows a side view (partial cross-sectional view) of a medical treatment instrument according to Embodiment 1 of the present invention; FIG. Figure 2 shows a cross-sectional view of the first fixation member of the fixation device shown in Figure 1; Figure 2 shows a side view of the second fixation member of the fixation device shown in Figure 1; FIG. 2 is a cross-sectional view (partial side view) of the fixing device of the medical treatment device shown in FIG. 1, showing a state in which no filamentous object is clamped; FIG. 5 is a cross-sectional view (partial side view) showing a state in which a filamentous object is clamped by the fixing device shown in FIG. 4; FIG. 6 is a cross-sectional view (partial side view) showing a modification of FIG. 5 ; FIG. 10 is a cross-sectional view (partial side view) of a fixing device for a medical treatment device according to Embodiment 2 of the present invention, showing a state in which no filamentous object is clamped; FIG. 8 is a cross-sectional view (partial side view) showing a state in which a filamentous object is clamped by the fixing device shown in FIG. 7; FIG. 10 is a cross-sectional view (partial side view) of a fixing device for a medical treatment device according to Embodiment 3 of the present invention, showing a state in which no filamentous object is clamped; FIG. 10 is a cross-sectional view (partial side view) showing a state in which a filamentous object is clamped by the fixing device shown in FIG. 9; FIG. 11 is a cross-sectional view (partial side view) of a fixing device for a medical treatment device according to Embodiment 4 of the present invention, showing a state in which no filamentous material is clamped; FIG. 12 is a cross-sectional view (partial side view) showing a state in which the fixing device shown in FIG. 11 clamps a filamentous object;

Hereinafter, the present invention will be described in more detail based on the following embodiments, but the present invention is not limited by the following embodiments, and can be modified appropriately within the scope of the above and later descriptions. It is of course possible to carry out in addition, and all of them are included in the technical scope of the present invention. In each drawing, for the sake of convenience, hatching, member symbols, etc. may be omitted, but in such cases, the specification and other drawings shall be referred to. In addition, the dimensions of various members in the drawings may differ from the actual dimensions, since priority is given to helping to understand the features of the present invention.

One embodiment of a medical treatment instrument according to the present invention includes an inner cylinder having a distal side and a proximal side, a filamentous material arranged in a lumen of the inner cylinder, and a distal side of the inner cylinder. and a treatment section connected to the distal side of the filamentous material, a fixing device disposed on the proximal side of the inner cylinder, holding the proximal side of the filamentous material, and satisfying the following conditions: The fixation device has a first fixation member having a nut portion, and a second fixation member having a bolt portion that is fitted to the nut portion and clamps the filamentous material, and is positioned proximally of the filamentous material. A knot is provided, and the gist is that the knot is arranged on the proximal side of the contact surface described below in the perspective direction of the filament.
[conditions]
In the fixing device, when the bolt portion is turned and advanced with respect to the nut portion in a state in which the filamentous object is not clamped, the first fixing member and the second fixing member are arranged such that the normal vector is parallel to the advancing direction of the bolt portion. Advancement is inhibited by direct or indirect contact with each other at contact surfaces having different components.

According to the above-described medical treatment instrument, the thread-like object is fixed by fitting the bolt portion of the second fixing member to the nut portion of the first fixing member while the thread-like object is arranged between the first fixing member and the second fixing member. It is possible to efficiently attach a fixing device to an object. Further, in the above medical treatment device, the knot of the filament is arranged closer to the proximal side of the filament in the distance direction than the contact surface between the first fixing member and the second fixing member when the filament is not sandwiched. ing. At this time, the portion of the filamentous material other than the knot is strongly held between the contact surfaces, but even if the filamentous material is pulled in the far and near directions, the knot cannot pass through this contact surface portion. Therefore, according to the medical treatment instrument, it is possible to prevent the filamentous material from coming off from the fixing instrument.

Medical treatment instruments are used for pinching and holding (countertraction) a lesion of an organ during treatment of tumors such as cancer (preferably endoscopic treatment), hemostasis, suturing, and marking in the body. Used for picking up tissue. Below, the medical treatment instrument may be simply referred to as a treatment instrument. Since the treatment instrument is to be inserted into the body, it is desirable that the materials of the members constituting the treatment instrument have biocompatibility.

In the present invention, the proximal side of the medical treatment instrument refers to the hand side of the user, that is, the operator with respect to the extending direction of the inner cylinder, and the distal side is the opposite direction to the proximal side, that is, the distal side. Refers to the side to be treated. Also, the direction from the proximal side to the distal side of the inner cylindrical body or the direction from the distal side to the proximal side is referred to as the far-near direction. The inner side of the medical treatment instrument refers to a direction toward the longitudinal center of the inner cylindrical body in the radial direction of the inner cylindrical body, and the outer side refers to a radial direction opposite to the inner side.

First, referring to FIG. 1, the inner cylinder, the filamentous material, and the treatment section will be described, and then the outer cylinder and the operation section, which are preferably provided, will be described. FIG. 1 shows a side view (partial cross-sectional view) of a medical treatment instrument according to Embodiment 1 of the present invention. In addition, in FIG. 1, the left side represents the distal side of the inner cylindrical body, and the right side represents the proximal side of the inner cylindrical body.

The inner cylindrical body 10 is a member that has a distal side and a proximal side and extends in the distal and near directions. A portion of the filamentous material 20 is arranged in the lumen 11 of the inner cylindrical body 10 . The inner barrel 10 has a tubular structure for placing a filament 20 in its lumen 11 . The inner cylindrical body 10 communicates with the outside through an opening provided on its distal side. The treatment section 30 is provided on the distal side of the filamentous material 20 exposed from the distal side opening of the inner cylindrical body 10 . A portion of the treatment section 30 may be arranged in the lumen 11 of the inner tubular body 10 . The inner tubular body 10 preferably has flexibility to bend along the shape of the body cavity. In addition, the inner cylindrical body 10 preferably has rigidity for reliably delivering the treatment portion 30 to the tissue to be treated.

The inner cylindrical body 10 includes a resin tube, a single wire or a plurality of wires, a cylindrical body formed by arranging a stranded wire in a specific pattern, a metal tube, or a combination thereof. A resin tube can be manufactured, for example, by extrusion molding. A cylindrical body in which wires are arranged in a specific pattern includes a cylindrical body having a network structure by simply crossing or weaving wires, and a coil in which wires are wound. The type of network structure is not particularly limited, nor is the number of coil turns or density. The mesh structure and coils may be formed with a constant density over the entire axial direction, or may be formed with different densities depending on the position in the distance direction. To increase the flexibility of the metal tube, the outer surface of the metal tube may be formed with a plurality of annular grooves or spiral grooves. Above all, it is preferable that the groove is formed on the outer surface, particularly the outer peripheral surface, on the distal side of the center of the metal tube in the axial direction.

The inner cylindrical body 10 is preferably made of resin or metal. Examples of the resin forming the inner cylindrical body 10 include polyamide-based resins, polyester-based resins, polyurethane-based resins, polyolefin-based resins such as polypropylene, fluorine-based resins, vinyl chloride-based resins, silicone-based resins, and natural rubber. These may use only 1 type and may use 2 or more types together. Among them, polyamide-based resins, polyester-based resins, polyurethane-based resins, polyolefin-based resins, and fluorine-based resins are preferably used. Examples of metals forming the inner cylindrical body 10 include stainless steels such as SUS301, SUS302, SUS303, SUS304, and SUS316, platinum, nickel, cobalt, chromium, titanium, tungsten, gold, Ni--Ti alloys, and Co--Cr alloys. , or combinations thereof. In particular, a wire made of a Ni—Ti alloy is excellent in shape memory and high elasticity. Moreover, the wire material may be a fiber material such as the above-mentioned metal, polyarylate fiber, aramid fiber, ultra-high molecular weight polyethylene fiber, PBO fiber, and carbon fiber. The fibrous material may be monofilament or multifilament. Alternatively, a tubular body made of resin and a reinforcing member such as a metal wire provided thereon may be used as the inner tubular body 10 .

The inner cylindrical body 10 may be composed of a single layer, or may be composed of multiple layers. Moreover, in the far-near direction, a part of the inner cylindrical body 10 may be composed of a single layer, and the other part may be composed of a plurality of layers.

The filamentous object 20 is arranged in the lumen 11 of the inner cylindrical body 10 and is a pulling member whose distal side is connected to the treatment section 30 . Tension can be applied to the treatment section 30 by pulling the filament 20 proximally. Also, by pulling out the filamentous material 20 from the inner cylindrical body 10, the treatment portion 30 and the lesion can be taken out of the body. Like inner barrel 10, thread 20 also has a distal side and a proximal side.

The filamentous material 20 preferably extends from the proximal side of the inner tubular body 10 to the outside of the inner tubular body 10 from the treatment portion 30 through the lumen 11 of the inner tubular body 10 . Specifically, it is preferable that the filamentous material 20 is exposed from an opening on the proximal side of the inner cylindrical body 10 . As a result, the proximal side of the filamentous material 20 can be clamped by a fixing device 40, which will be described later. In addition, when a first operating portion 61 to be described later is connected to the proximal side of the inner tubular body 10 , it is preferable that the filamentous material 20 is exposed from an opening on the proximal side of the first operating portion 61 . .

Thread 20 has a longitudinal direction. As shown in FIG. 1 , one longitudinal end of filament 20 may be connected to treatment section 30 , and the other longitudinal end of filament 20 may be clamped by fixing device 40 . Although not shown, the filamentous material 20 has a longitudinally midway portion folded back, a longitudinally midway portion of the filamentous material 20 is connected to the treatment section 30, and one end and the other end of the filamentous material 20 are connected to each other. The part may be clamped by the fixture 40 . Further, although not shown, when the filamentous material 20 is folded back in the longitudinal direction, one longitudinal end and the other longitudinal end of the filamentous material 20 are connected to the treatment section 30, and the filamentous material Longitudinal folds 20 may be clamped by fasteners 40 .

The method of connecting the filamentous object 20 and the treatment section 30 is not particularly limited, and one end or the other end in the longitudinal direction of the filamentous object 20, or both one end and the other end may be tied to the treatment section 30. , the longitudinal middle portion of the filamentous material 20 may be hooked on the treatment portion 30 . In addition, a connecting member for connecting the filamentous material 20 and the treatment section 30 may be provided on the filamentous material 20, the treatment section 30, or both.

The filamentous material 20 may be a single yarn or a twisted yarn formed from a plurality of yarns. Alternatively, the filament 20 may be formed by a plurality of single yarns or twisted yarns woven or knitted together. The filamentous material 20 may be solid or hollow.

The shape of the cross section perpendicular to the longitudinal direction of the thread 20 can be circular, elliptical, polygonal, or a combination thereof. From the viewpoint of easy handling of the filamentous material 20, it is preferable that the filamentous material 20 has a flat cross-sectional shape.

A knot 21 is provided on the proximal side of thread 20 . The knot 21 is a knot formed by tying a portion of the filament 20 . The maximum outer diameter of the knot 21 is larger than the outer diameter of the portion of the filamentous material 20 other than the knot 21 .

Only one knot 21 may be provided, or a plurality of knots may be provided. When a plurality of knots 21 are provided, it is preferable that the plurality of knots 21 be arranged apart from each other in the direction of the thread-like material 20 . Also, the maximum outer diameters of the plurality of knots 21 may be the same or different from each other. The maximum outer diameter of the plurality of knots 21 may be larger as they are located closer to the proximal side. The number of knots 21 described here refers to the number of knots 21 arranged on the proximal side of the filament 20 (that is, on the proximal side of the center of the filament 20 in the perspective direction). and does not include the knot formed when connecting the filamentous object 20 to the treatment portion 30 .

Examples of the types of the knot 21 include a stop knot, a hard stop knot, a figure eight knot, a double stop knot, a double figure eight knot, and a double knot. Although not shown, a loop may be formed on the proximal side of the knot 21 in the perspective direction of the filamentous material 20 . Since the operator can pass the finger through the loop when gripping the fixing device 40 and hook it, it is possible to further prevent the filamentous material 20 from slipping out of the fixing device 40 .

The filamentous material 20 is preferably made of a material having biocompatibility and strength. For example, polyamide resin such as nylon, polyolefin resin such as polypropylene, polyester resin such as polyethylene terephthalate, fluororesin such as PTFE, and the like. can be used. These may use only 1 type and may use 2 or more types together. Among others, it is preferable that the filamentous material 20 is made of a material containing fluororesin. As a result, the slidability of the filamentous material 20 can be improved and the friction between the filamentous material 20 and the treatment section 30 can be reduced. It can prevent disconnection. Further, the outer surface of the filamentous material 20 may be coated with a fluororesin. As the fluororesin, for example, PTFE, tetrafluoroethylene/hexafluoropropylene copolymer (FEP), ethylene/tetrafluoroethylene copolymer (ETFE), and the like can be used. For coating the filamentous material 20 with the fluororesin, for example, an immersion method, a spray method, a fluidized bed method, a kneader coater method, or the like can be used.

In order to smoothly pull out the filamentous material 20 from the body, it is desirable to appropriately adjust the length of the filamentous material 20 according to the type of procedure. Preferably, the distal end of thread 20 is connected to treatment portion 30 and the proximal end is proximal to knot 21 . Here, the length of the filamentous material 20 does not refer to the entire length of the filamentous material 20, but the length from the distal end to the proximal end thereof, even if the filamentous material 20 is folded back and has a plurality of threads. say.

The treatment section 30 is a portion arranged on the distal side of the inner cylinder 10 and connected to the distal side of the filamentous material 20 . As the treatment section 30, a ligating device such as a clip 31 for gripping tissue in the body and an indwelling snare can be used. The treatment portion 30 is arranged to protrude from the distal opening of the inner cylindrical body 10 .

The treatment portion 30 is a clip 31 that grips tissue in the body. The clip 31 has two clamping base materials 32 . Preferably, a fastener 35 is provided that has a large diameter and is axially movable. Since the treatment portion 30 is the clip 31, it can be used for hemostasis of internal tissue. Further, since the clip 31 is provided with the fastener 35, the degree of opening and closing of the clip 31 can be adjusted. The fastener 35 is arranged to surround the proximal outside of the clip 31 in the open state. The fastener 35 is then moved distally of the clip 31 by retracting the clip 31 proximally of the inner barrel 10 . As the fastener 35 moves distally of the clip 31, a radially inward pushing force is applied to the clamping bases 32 by the fasteners 35, causing the two clamping bases 32 to approach each other. Therefore, the clip 31 is closed.

The sandwiching base material 32 can be formed from a belt-shaped member having a longitudinal direction and a lateral direction. The thickness of the belt-shaped member (that is, the thickness in the direction perpendicular to both the longitudinal direction and the lateral direction) is, for example, 0.1 mm or more and 0.5 mm or less. The sandwiching base material 32 can be formed by bending a portion of the belt-shaped member in the longitudinal direction, or by separately manufacturing a plurality of belt-shaped members and then joining these belt-shaped members to each other by a method such as laser welding. The two holding base materials 32 are arranged facing each other. The two clamping base materials 32 can be formed in a shape symmetrical with respect to the long axis of the clip 31 in order to facilitate matching the timing of approaching the two clamping base materials 32 when the clip 31 is closed. Alternatively, the proximal ends of the two clamping substrates 32 may be fixed together. Although the fixing method is not particularly limited, for example, methods such as mechanical fixing using screws, caulking, etc., welding, and adhesion can be used.

The fastener 35 encloses at least part of the clip 31 and is preferably formed in a tubular shape. The fastener 35 is arranged outside the clip 31 so as to be movable in the longitudinal direction of the clip 31 . As the fastener 35, a tubular member such as a cylindrical body or a square tubular body can be used. The tubular member may be in the shape of a single cylinder, or may be in the shape of a hollow coil formed by winding a wire rod. Further, the cylindrical member may have a closed ring shape that is closed in the circumferential direction, or an open ring shape that is open in the circumferential direction and, for example, a C-shaped cross section perpendicular to the longitudinal direction.

The treatment portion 30 is preferably made of, for example, stainless steel such as SUS301, SUS302, SUS303, SUS304, SUS631, Ni—Ti alloy, or the like. When the treatment portion 30 is the clip 31, the clip 31 and the fastener 35 may be made of the same material or may be made of different materials.

It is preferable that the treatment instrument 1 further includes an outer tubular body 55 that encloses at least part of the inner tubular body 10 in the distance direction. The outer cylindrical body 55 has a distal side and a proximal side like the inner cylindrical body 10 . The outer tubular body 55 has a tubular structure like the inner tubular body 10 . As a result, since at least a part of the inner cylinder 10 and the treatment portion 30 are housed in the lumen 56 of the outer cylinder 55, the tissue not to be treated, the inside of the forceps channel of the endoscope, and the forceps port are less likely to be damaged.

As with the inner cylinder 10, the outer cylinder 55 is a resin tube, a single wire or a plurality of wires, a cylinder formed by arranging a stranded wire in a specific pattern, a metal tube, or a combination thereof. can be used. The outer cylinder 55 can be made of the resin or metal described as the constituent material of the inner cylinder 10 . The material of the outer cylinder 55 may be the same as or different from the material of the inner cylinder 10 .

In order to configure the inner cylinder 10 to be movable in the distance direction with respect to the outer cylinder 55, it is preferable that the inner cylinder 10 and the outer cylinder 55 are not fixed to each other.

The perspective direction of the outer cylinder 55 is preferably parallel to the perspective direction of the inner cylinder 10 . This makes it easier for the outer cylinder 55 to move along the distance direction of the inner cylinder 10 .

It is preferable that an operating portion for gripping the treatment instrument 1 by an operator is provided on the proximal side of the treatment instrument 1 . For example, the treatment instrument 1 may have a first operation portion 61 connected to the proximal side of the inner tubular body 10 . As a result, the inner cylinder 10 can be gripped, so that the operation of moving the outer cylinder 55 with respect to the inner cylinder 10 in the distance direction is facilitated. In addition, it is preferable that the first operating portion 61 protrude radially outward from the inner tubular body 10 . Although not shown, the first operating portion 61 preferably has a hollow portion for inserting the filamentous material 20 in the distance direction.

The treatment instrument 1 may have a second operating portion 62 connected to the proximal side of the outer cylinder 55 . This makes it easier to move the outer cylindrical body 55 in the distance direction. In addition, it is preferable that the second operating portion 62 protrude radially outward from the outer cylindrical body 55 . A cylindrical body can be used as the second operation portion 62 .

As for the constituent materials of the first operating portion 61 and the second operating portion 62, the description of the material of the fixing device 40, which will be described later, can be referred to.

The bonding between the first operating portion 61 and the inner cylinder 10, and between the second operating portion 62 and the outer cylinder 55 can be performed using conventionally known bonding means such as adhesives and heat welding.

The basic configuration of the fixing device 40 will be described with reference to FIGS. 2 to 5. FIG. 2 and 3 respectively show a cross-sectional view of the first fixing member 41 and a side view of the second fixing member 45 of the fixing device 40 shown in FIG. 4 and 5 are cross-sectional views (partial side views) of the fixing device 40 of the medical treatment device 1 shown in FIG. 1, and FIG. 5 shows a state in which the fixing device 40 clamps the filamentous material 20 .

The fixing device 40 is arranged on the proximal side of the inner tubular body 10, clamps the proximal side of the filamentous material 20, and satisfies the following conditions. It has a fixing member 41 and a second fixing member 45 having a bolt portion 46 that is fitted to the nut portion 42 to hold the filamentous material 20 therebetween. The knot 21 is arranged closer to the proximal side than the contact surface 49 described below in the distance direction of the filamentous object 20 .
[conditions]
In the fixing device 40, when the bolt portion 46 is turned and advanced with respect to the nut portion 42 in a state in which the filamentous object 20 is not clamped, the first fixing member 41 and the second fixing member 45 are positioned such that the normal vector N is Advancement is stopped by direct or indirect contact with each other at the contact surface 49 having a component Nx parallel to the advance direction x of the bolt portion 46 .

Since the fixation device 40 clamps the filamentous object 20 on the proximal side, the filamentous object 20 can be moved in the distance direction by clamping the fixation device 40 . The operator can move the filamentous material 20 more easily than when the filamentous material 20 is directly grasped. According to the treatment instrument 1, as shown in FIGS. 4 and 5, the thread 20 is placed between the first fixing member 41 and the second fixing member 45, and the bolt portion 46 of the second fixing member 45 is pushed to the second position. By fitting the nut portion 42 of the 1 fixing member 41, the fixing device 40 can be attached to the filamentous object 20 efficiently. In addition, in the treatment instrument 1, the knot 21 of the filamentous object 20 is closer to the filamentous object 20 in the perspective direction than the contact surface 49 of the first fixing member 41 and the second fixing member 45 when the filamentous object 20 is not sandwiched. placed proximally. At this time, the portion of the filamentous object 20 other than the knot 21 is strongly clamped by the contact surface 49, but even if the filamentous object 20 is pulled in the far and near directions, the knot 21 does not pass through this contact surface 49 portion. can't Therefore, according to the treatment instrument 1 , it is possible to prevent the filamentous material 20 from slipping out of the fixing instrument 40 .

The normal vector N of the contact surface 49 should include a component Nx parallel to the advance direction x of the bolt portion 46 . Note that FIG. 4 shows an example in which the normal vector N of the contact surface 49 is composed only of a component Nx parallel to the advance direction x of the bolt portion 46 . 7, the normal vector N of the contact surface 49 has a component Nx parallel to the forward direction x of the bolt portion 46 and a component Ny perpendicular to the forward direction x of the bolt portion 46. good too.

The contact surface 49 of the fixing device 40 and the knot 21 of the filamentous object 20 need only be in the positional relationship described above, and the fixing device 40 may clamp the other end of the filamentous object 20 in the longitudinal direction. It may hold one end and the other end in the longitudinal direction, or may hold the folded portion of the filamentous material 20 in the longitudinal direction.

In the present invention, the contact surface 49 is defined by the state in which the fixing device 40 does not clamp the filamentous material 20, but for the sake of convenience in this specification, the contact surface 49 is defined even in the state in which the fixing device 40 clamps the filamentous object 20. The description is given with the portion corresponding to 49 as the contact surface 49 .

As shown in FIG. 2 , the shape of the first fixing member 41 is not particularly limited as long as it has the nut portion 42 . Here, the cylindrical shape includes a bottomed cylindrical shape in which one end of the cylinder is open and the other end is closed. A nut portion 42 can be formed on the inner surface of the first fixing member 41 having a cylindrical shape. The outer diameter and inner diameter of the cylindrical first fixing member 41 may each have a constant value in the cylindrical axial direction of the first fixing member 41, or may differ depending on the position in the cylindrical axial direction. good.

As shown in FIG. 3, the shape of the second fixing member 45 is not particularly limited as long as it has the bolt portion 46. However, the forward direction x of the bolt portion 46 and the radial direction perpendicular to the forward direction x It may have a shape, in particular a bar shape. The second fixing member 45 may be solid or hollow. The bolt portion 46 can be the portion where the thread is formed on the outer surface of the second fixing member 45 . The outer diameter of the second fixing member 45 having the forward direction x and the radial direction of the bolt portion 46 may have a constant value in the forward direction x of the bolt portion 46 of the second fixing member 45 . The size may differ depending on the position in the forward direction x of the .

The first fixing member 41 and the second fixing member 45 are preferably made of resin, metal, or ceramic. Examples of resins forming the first fixing member 41 and the second fixing member 45 include polycarbonate resin, acrylic resin, polyethylene resin, polyethylene terephthalate resin, acrylonitrile-butadiene-styrene copolymer (ABS resin), polyurethane resin, and polyacetal. Resin, nylon resin, etc. can be mentioned. Further, examples of the metal forming the first fixing member 41 and the second fixing member 45 include stainless steel such as SUS301, SUS302, SUS303, SUS304, and SUS631, and Ni—Ti alloys. The constituent materials of the first fixing member 41 and the second fixing member 45 may be the same or different.

It is preferable that the first fixing member 41 and the second fixing member 45 are each made of an elastic member. As a result, when fitting the second fixing member 45 to the first fixing member 41, these members can be elastically deformed. can be done.

Either one of the first fixing member 41 and the second fixing member 45 may be made of a material having a higher elastic modulus than the other. For example, it is preferable that the elastic modulus of the first fixing member 41 is higher than the elastic modulus of the second fixing member 45 . As a result, the first fixing member 41 and the second fixing member 45 can be fitted together more reliably.

In order to fit the first fixing member 41 and the second fixing member 45 together, the extending direction of the thread axis L1 of the nut portion 42 of the first fixing member 41 (hereinafter referred to as "the axial direction of the nut portion 42") is , and the advancing direction x of the bolt portion 46 of the second fixing member 45 (that is, the extending direction of the thread axis L2 of the bolt portion 46), which will be described later.

The axial direction of the nut portion 42 is not particularly limited, and may be parallel to the perspective direction of the inner tubular body 10 or parallel to the radial direction of the inner tubular body 10 . is preferred. This makes it easier to move the filamentous object 20 in the near and far directions.

The advancing direction x of the bolt portion 46 of the second fixing member 45, that is, the extending direction of the thread axis L2 of the bolt portion 46 is not particularly limited. , but preferably parallel to the perspective direction of the inner cylindrical body 10 . This makes it easier to move the filamentous object 20 in the near and far directions.

As shown in FIG. 2 , it is preferable that the nut portion 42 is arranged on a portion of the first fixing member 41 in the axial direction of the nut portion 42 . As a result, the shape of the first fixing member 41 can be designed with a degree of freedom. Although not shown, the nut portion 42 may be arranged over the entire first fixing member 41 in the axial direction of the nut portion 42 .

As shown in FIG. 2 , the first fixing member 41 preferably has a tube portion 43 provided adjacent to the nut portion 42 in the axial direction of the nut portion 42 . As a result, the filamentous material 20 can be arranged in the tube portion 43, so that the filamentous material 20 easily extends from the tube portion 43 toward the nut portion 42, and the filamentous material 20 is clamped by the fixing device 40. easier.

As shown in FIG. 3, the second fixing member 45 preferably has a grip portion 48 provided adjacent to the bolt portion 46 in the forward direction x of the bolt portion 46 . By holding the holding portion 48 by the operator, it becomes easier to move the filamentous material 20 .

It is preferable that the grasping portion 48 extends along the advancing direction x of the bolt portion 46 so that the operator can easily grasp the grasping portion 48 . For the same reason, it is preferable that the grip portion 48 is formed longer than the bolt portion 46 in the advancing direction x of the bolt portion 46 . Therefore, the grip part 48 can be formed, for example, in the shape of a solid or hollow rod.

It is preferable that the outer surface of the grip portion 48 is formed with irregularities. This makes it difficult for the operator to slip when gripping the grip part 48 , so that the operator can easily move the filamentous material 20 . Examples of the method of providing unevenness on the outer surface of the grip portion 48 include a method of molding with a mold provided with unevenness, and a method of cutting so as to provide unevenness.

Although not shown, the outer surface of the grip portion 48 may be provided with an elastic material for slip prevention. Providing the elastic material in this way also makes it easier for the operator to securely grip the grip portion 48 . As for the constituent material of the elastic member, the explanation of the material of the ring member 50 to be described later can be referred to.

As shown in FIG. 3, the second fixing member 45 is provided adjacent to the bolt portion 46 in the advancing direction x of the bolt portion 46, and has a large diameter portion 47 having an outer diameter larger than the maximum outer diameter of the bolt portion 46. It is preferable to have The large diameter portion 47 is arranged on the front side of the bolt portion 46 with respect to the advance direction x of the bolt portion. As a result, the large-diameter portion 47 of the second fixing member 45 comes into contact with the first fixing member 41 when the fixing device 40 does not sandwich the filamentous object 20 , thereby making it easier for the bolt portion 46 to be prevented from advancing forward. . As a result, the filamentous material 20 can be firmly held by the fixing device 40 .

The bolt portion 46 is preferably longer than the large diameter portion 47 in the forward direction x of the bolt portion 46 . As a result, since the bolt portion 46 and the nut portion 42 can be fitted over a wide range, a long section of the filamentous material 20 sandwiched by the fixing device 40 can be ensured, thereby preventing the filamentous material 20 from coming off. can increase The bolt portion 46 may be shorter than the large diameter portion 47 in the forward direction x of the bolt portion 46 . As a result, the bolt portion 46 and the nut portion 42 can be fitted quickly.

The outer diameter of the large-diameter portion 47 may be constant in the forward direction x of the bolt portion 46 or may vary depending on the position of the bolt portion 46 in the forward direction x. Moreover, the large diameter portion 47 may have a step, and the large diameter portion 47 may have a tapered portion in which the outer diameter decreases toward the bolt portion 46 side. 3, the large-diameter portion 47 is provided adjacent to the first large-diameter portion 47A and the first large-diameter portion 47A in the advancing direction x of the bolt portion 46, and is located closer to the first large-diameter portion 47A than the first large-diameter portion 47A. A second large diameter portion 47B having a large outer diameter is provided, and the first large diameter portion 47A is arranged on the bolt portion 46 side.

Although not shown, when the second fixing member 45 has the bolt portion 46 and the large diameter portion 47, the large diameter portion 47 may also serve as the grip portion. That is, the outer surface of the large-diameter portion 47 may be uneven, or the outer surface of the large-diameter portion 47 may be provided with an elastic material. In that case, the operator can operate the filamentous object 20 by gripping the large diameter portion 47 .

When the second fixing member 45 has the bolt portion 46, the large diameter portion 47, and the grip portion 48, as shown in FIG. , the grip portion 48 is preferably arranged in this order. In that case, the outer diameter of the large diameter portion 47 is preferably larger than the outer diameter of the grip portion 48 . This makes it easier for the large-diameter portion 47 to come into contact with the first fixing member 41 , and makes it easier for the operator to grip the grip portion 48 .

As shown in FIG. 5 , when the bolt portion 46 is mated with the nut portion 42 , the distal end of the first fixing member 41 is located farther from the distal end of the second fixing member 45 than the distal end of the filament 20 . Distal placement is preferred. By arranging the first fixing member 41 and the second fixing member 45 in this manner, the filamentous material 20 is firmly held. In this aspect, in the manufacturing process of the treatment instrument 1, the bolt portion 46 of the second fixing member 45 is inserted into the nut portion 42 of the first fixing member 41 from the proximal side of the first fixing member 41 and turned forward. Thus, the bolt portion 46 is fitted to the nut portion 42 to hold the filamentous material 20 therebetween.

As shown in FIGS. 4 and 5, the first fixing member 41 is provided with a tube portion 43 and a nut portion 42 in order from the distal side, and the second fixing member 45 is provided with a bolt portion 46 in order from the distal side. , a large diameter portion 47 and a grip portion 48 are preferably provided.

The first fixing member 41 preferably has a concave portion 44 that is provided adjacent to the nut portion 42 in the advancing direction x of the bolt portion 46 and receives the large diameter portion 47 . As a result, the large-diameter portion 47 of the second fixing member 45 comes into contact with the concave portion 44 of the first fixing member 41 in a state where the fixing device 40 does not clamp the filamentous object 20, thereby preventing the forward movement of the bolt portion 46. easier to be

The second fixing member 45 is provided adjacent to the bolt portion 46 in the advancing direction x of the bolt portion 46, and has a large diameter portion 47 having an outer diameter larger than the maximum outer diameter of the bolt portion 46. The member 41 is provided adjacent to the nut portion 42 in the advance direction x of the bolt portion 46 and has a recess 44 for receiving the large diameter portion 47, and the fixing device 40 is in a state where the filamentous object 20 is not clamped. It is preferable that the bottom surface 44A of the concave portion 44 of the first fixing member 41 is in direct or indirect contact with the distal or proximal end surface of the large diameter portion 47 of the second fixing member 45 . By bringing the first fixing member 41 and the second fixing member 45 into contact with each other at the contact surface 49 in this way, the knot 21 of the filamentous material 20 is less likely to pass through the contact surface 49 . In FIG. 4, the bottom surface 44A of the concave portion 44 of the first fixing member 41 is in direct contact with the distal end surface 47C of the large diameter portion 47 of the second fixing member 45 when the filamentous material 20 is not sandwiched. example.

It is preferable that the maximum inner diameter of the concave portion 44 of the first fixing member 41 is larger than the maximum inner diameter of the nut portion 42 . This makes it easier for the recessed portion 44 of the first fixing member 41 to abut against the large-diameter portion 47 of the second fixing member 45, so that the first fixing member 41 and the second fixing member 45 can be reliably brought into contact with each other.

In the fixing device 40, the inner peripheral surface 44B of the concave portion 44 of the first fixing member 41 is directly or indirectly attached to the outer peripheral surface 47D of the large diameter portion 47 of the second fixing member 45 in a state where the filamentous object 20 is not sandwiched. preferably in contact with As a result, the first fixing member 41 and the second fixing member 45 can be further brought into contact with each other at a portion other than the contact surface 49, so that the thread 20 can be prevented from coming off from the fixing device 40. 4, the inner peripheral surface 44B of the concave portion 44 of the first fixing member 41 corresponds to the outer peripheral surface 47D of the large diameter portion 47 of the second fixing member 45 (more specifically, the outer peripheral surface 47AD of the first large diameter portion 47A). shows an example of direct contact with

Although not shown, the maximum outer diameter of the second fixing member 45 may be larger or smaller than the maximum outer diameter of the first fixing member 41 . Further, the maximum outer diameter of the first fixing member 41 and the maximum outer diameter of the second fixing member 45 may be the same so that the operator can easily grasp the fixing device 40 .

The position of the knot 21 in the perspective direction of the filamentous object 20 is not particularly limited as long as it is arranged on the proximal side of the contact surface 49, but as shown in FIG. is preferred. This makes it difficult for the knot 21 to pass through the portion of the contact surface 49 , thereby preventing the filamentous object 20 from slipping out of the fixing device 40 .

Preferably, the knot 21 is external to the fixation device 40, as shown in FIG. As a result, since the portion of the filamentous material 20 other than the knot 21 is arranged on the contact surface 49, the gap between the first fixing member 41 and the second fixing member 45 that is formed when the filamentous material 20 is clamped can be reduced. can do. Therefore, it is possible to prevent the filamentous material 20 from coming off from the fixing device 40 . The fact that the knot 21 exists outside the fixing device 40 means that the knot 21 is arranged radially outward of the fixing device 40 .

FIG. 5 shows an example in which the knot 21 of the filamentous material 20 is arranged on the proximal side of the first fixing member 41 in the far-near direction of the inner cylinder 10, but in the far-near direction of the inner cylinder 10, The knot 21 of the filament 20 may be arranged proximally of the second fixing member 45 .

FIG. 6 is a cross-sectional view (partial side view) showing a modification of FIG. As shown in FIG. 6, the knot 21 may be sandwiched between the first fixing member 41 and the second fixing member 45 . As a result, the portion of the filamentous object 20 other than the knot 21 is strongly held by the contact surface 49, and the knot 21 is held by the portion other than the contact surface 49, thereby preventing the filamentous object 20 from coming off the fixing device 40. more can be prevented.

For example, as shown in FIG. 6, the knot 21 may be clamped by the first fixing member 41 and the second fixing member 45 from a direction parallel to the advancing direction x of the bolt portion 46 . Specifically, when the second fixing member 45 is provided with the first large diameter portion 47A and the second large diameter portion 47B, the knot 21 is formed between the proximal end surface of the first fixing member 41 and the second large diameter portion. It is preferably clamped by the distal end face of 47B.

Although not shown, the knot 21 may be held between the inner peripheral surface 44B of the recess 44 of the first fixing member 41 and the outer peripheral surface 47AD of the first large diameter portion 47 of the second fixing member 45.

Although only part of the knot 21 may be sandwiched between the first fixing member 41 and the second fixing member 45, in order to enhance the effect of preventing the filamentous object 20 from coming off the fixing device 40, the entire knot 21 may be held by the second fixing member 45. It is preferable to be sandwiched between the first fixing member 41 and the second fixing member 45 .

Although not shown, the filamentous material 20 may be wound around the bolt portion 46 of the second fixing member 45 on the distal side of the knot 21 in the far-near direction of the filamentous material 20 . Even if the operator grips the fixing device 40 and moves the filamentous material 20, since the filamentous material 20 is wound around the bolt portion 46, the effect of preventing the filamentous material 20 from coming off from the fixing device 40 is further enhanced. Increased.

Although not shown, the fixing device 40 preferably has an adhesive portion where the first fixing member 41 and the second fixing member 45 are adhered to each other. As a result, the first fixing member 41 and the second fixing member 45 can be firmly fixed, so that the filamentous material 20 can be prevented from slipping out of the fixing device 40 .

The adhesive portion is preferably joined to the filamentous material 20 . As a result, not only the first fixing member 41 and the second fixing member 45 but also the filamentous material 20 can be adhered to each other.

Examples of the material forming the adhesive portion include polyurethane-based, epoxy-based, cyano-based, and silicone-based adhesives.

A fixing device 40 of a medical treatment device 1 according to Embodiment 2 of the present invention will be described. 7 and 8 are cross-sectional views (partial side views) of the fixing device 40 of the medical treatment device 1 according to Embodiment 2 of the present invention, and FIG. FIG. 8 shows a state in which the fixing device 40 is clamping the filamentous material 20. As shown in FIG. The description of the same configuration as that of the medical treatment instrument 1 according to Embodiment 1 will be omitted.

As shown in FIGS. 7 and 8, when the fixing device 40 rotates and advances the bolt portion 46 with respect to the nut portion 42 in a state in which the filamentous object 20 is not clamped, the first fixing member 41 and the second fixing member 41 are separated from each other. The normal vector N of the contact surface 49 where the fixing members 45 contact each other may have a component Nx parallel to the advancing direction x of the bolt portion 46 and a component Ny perpendicular to the advancing direction x of the bolt portion 46. . That is, the contact surface 49 may be inclined with respect to the advancing direction x of the bolt portion 46 . Forming the contact surface 49 in this way also has the effect of preventing the filamentous object 20 from slipping out of the fixing device 40 .

The normal vector N of the contact surface 49 where the first fixing member 41 and the second fixing member 45 contact each other has a component Nx parallel to the forward direction x of the bolt portion 46 and a component Ny perpendicular to the forward direction x of the bolt portion 46 . For example, the large-diameter portion 47 of the second fixing member 45 has a tapered portion in which the outer diameter decreases in the advancing direction x of the bolt portion 46. be done. Since the large-diameter portion 47 has the tapered portion, the second fixing member 45 can be smoothly inserted into the first fixing member 41 . FIG. 7 shows an example in which the first large diameter portion 47A of the large diameter portion 47 has a tapered portion 47E whose outer diameter is reduced in the advancing direction x of the bolt portion 46. As shown in FIG.

When the large-diameter portion 47 of the second fixing member 45 has a tapered portion 47E whose outer diameter is reduced in the advancing direction x of the bolt portion 46, the concave portion 44 of the first fixing member 41 has an inner diameter preferably has an inner tapered portion 44C that tapers in the advancing direction x of the bolt portion 46. As shown in FIG. This makes it easier for the first fixing member 41 to receive the second fixing member 45 and also makes it easier to ensure a wide contact surface 49 .

In the cross section along the forward direction x of the bolt portion 46 of the fixing device 40, the inclination angle of the extending direction of the outline of the tapered portion 47E of the large diameter portion 47 of the first fixing member 41 with respect to the forward direction x of the bolt portion 46 is For example, it can be 20 degrees or more, 30 degrees or more, 45 degrees or more, or 80 degrees or less, 70 degrees or less, or 60 degrees or less.

In a cross section along the advancing direction x of the bolt portion 46 of the fixing device 40, the inclination angle of the extending direction of the outline of the inner tapered portion 44C of the recess 44 of the second fixing member 45 with respect to the advancing direction x of the bolt portion 46 is For example, it can be 20 degrees or more, 30 degrees or more, 45 degrees or more, or 80 degrees or less, 70 degrees or less, or 60 degrees or less.

The inclination angle of the extending direction of the outline of the tapered portion 47E with respect to the forward direction x of the bolt portion 46 and the inclination angle of the extending direction of the outline of the inner tapered portion 44C relative to the forward direction x of the bolt portion 46 are different from each other. However, in order to ensure a wide contact surface 49, it is preferable that the inclination angles are the same.

A fixing device 40 of a medical treatment device 1 according to Embodiment 3 of the present invention will be described. 9 and 10 are cross-sectional views (partial side views) of the fixing device 40 of the medical treatment device 1 according to Embodiment 3 of the present invention, and FIG. FIG. 10 shows a state in which the fixing device 40 is clamping the filamentous material 20. FIG. Note that description of the same configuration as that of the medical treatment instrument 1 according to Embodiments 1 and 2 will be omitted.

As shown in FIG. 10 , when the bolt portion 46 is fitted to the nut portion 42 , the distal end of the second fixing member 45 is located farther from the distal end of the first fixing member 41 than the distal end of the filament 20 . Distal placement is preferred. By arranging the first fixing member 41 and the second fixing member 45 in this way as well, the filamentous material 20 can be firmly held. In this aspect, in the manufacturing process of the treatment instrument 1, the nut portion 42 of the first fixing member 41 is put on the bolt portion 46 of the second fixing member 45 from the proximal side of the second fixing member 45 and turned forward. , the nut portion 42 is fitted to the bolt portion 46 to hold the filamentous material 20 therebetween.

As shown in FIG. 10, it is preferable that the knot 21 of the filamentous material 20 is arranged on the proximal side of the second fixing member 45 in the advancing direction x of the bolt portion 46 . As a result, the operator can visually confirm the position of the knot 21 of the filamentous object 20 , making it easier to confirm whether the filamentous object 20 has come off from the fixing device 40 .

Although not shown, the knot 21 of the filament 20 may be disposed within the tube portion 43 of the first fixing member 41 and connected to the nut portion 42 of the first fixing member 41 and the bolt portion 46 of the second fixing member 45. may be sandwiched between

A fixing device 40 of a medical treatment device 1 according to Embodiment 4 of the present invention will be described. 11 and 12 are cross-sectional views (partial side views) of the fixing device 40 of the medical treatment device 1 according to Embodiment 4 of the present invention, and FIG. FIG. 12 shows a state in which the fixing device 40 is clamping the filamentous material 20. FIG. Note that description of the same configuration as that of the medical treatment instrument 1 according to Embodiments 1 to 3 will be omitted.

As shown in FIGS. 11 and 12, the first fixing member 41 and the second fixing member 45 come into contact with each other via the ring member 50 on the contact surface 49 when the fixing device 40 does not sandwich the filamentous material 20. preferably. By providing the ring member 50 in this manner, the gap between the first fixing member 41 and the second fixing member 45 can be closed, so that the knot 21 can be prevented from passing through the contact surface 49 .

The shape of the ring member 50 is not particularly limited. It may be a ring in the shape of a combination of polygons. Alternatively, the ring member 50 may be a rectangular flat ring with a flat cross section. In addition, D-rings, X-rings, T-rings, C-rings, E-rings and U-rings may be used. FIG. 11 shows an example in which the ring member 50 is a rectangular flat ring with a flat cross section.

The ring member 50 may have a closed ring shape that is closed or an open ring shape that is partially open in the circumferential direction. From the viewpoint of preventing passage through the contact surface 49 of the second fixing member 45, the closed ring shape is preferable.

The ring member 50 is preferably provided within the recess 44 of the first fixing member 41 . Therefore, the ring member 50 is preferably provided on the large diameter portion 47 (preferably the first large diameter portion 47A) of the second fixing member 45 . 11 and 12, the ring member 50 is in contact with the bottom surface 44A of the recess 44 of the first fixing member 41 and the distal end surface of the second large diameter portion 47B of the second fixing member 45 at the contact surface 49. there is In addition, it is preferable that the center of the opening of the ring member 50 coincides with the advancing direction x of the bolt portion 46 .

As shown in FIG. 12, at contact surface 49, thread 20 may be sandwiched between ring member 50 and first securing member 41, and at contact surface 49, thread 20 may be sandwiched between ring member 50 and second securing member 41. It may be sandwiched between fixing members 45 (not shown).

The ring member 50 is preferably made of resin or metal. Examples of the resin constituting the ring member 50 include polyamide-based resin, polyester-based resin, polyurethane-based resin, polyolefin-based resin, fluorine-based resin, vinyl chloride-based resin, silicone-based resin, natural rubber such as latex, urethane rubber, and silicone rubber. and other synthetic rubbers. Examples of metals forming the ring member 50 include stainless steels such as SUS301, SUS302, SUS303, SUS304, and SUS316, platinum, nickel, cobalt, chromium, titanium, tungsten, gold, Ni—Ti alloys, Co—Cr alloys, Or a combination thereof. In order to effectively close the gap between the first fixing member 41 and the second fixing member 45, it is preferable that the ring member 50 is elastically deformed. Therefore, the ring member 50 is preferably made of resin. The constituent material of the ring member 50 may be the same as at least one of the first fixing member 41 and the second fixing member 45, or may be different from at least one of them.

1: Medical treatment device 10: Inner cylinder 11: Lumen 20: Filament 21: Knot 30: Treatment part 31: Clip 32: Clamping base material 35: Fastener 40: Fixing device 41: First fixing member 42: Nut portion 43: Pipe portion 44: Recessed portion 44A: Bottom surface 44B: Inner peripheral surface 44C: Inner tapered portion 45: Second fixing member 46: Bolt portion 47: Large diameter portion 47A: First large diameter portion 47AD: First large diameter Part outer peripheral surface 47B: second large diameter portion 47C: distal end surface 47D: outer peripheral surface 47E: tapered portion 48: gripping portion 49: contact surface 50: ring member 55: outer cylindrical body 56: lumen 61: first operation Part 62: Second operating part L1: Thread axis line L2 of the nut part: Thread axis line of the bolt part N: Normal vector Nx: Component parallel to the advancing direction of the bolt part Ny: Component perpendicular to the advancing direction of the bolt part x: advance direction of the bolt part

Claims (14)

an inner barrel having a distal side and a proximal side;
a filament disposed in the lumen of the inner cylindrical body;
a treatment section disposed on the distal side of the inner cylindrical body and connected to the distal side of the filament;
a fixing device disposed on the proximal side of the inner cylindrical body, holding the proximal side of the filament, and satisfying the following conditions;
The treatment section can be arranged in the lumen of the inner cylindrical body,
The fixing device has a first fixing member having a nut portion, and a second fixing member having a bolt portion that is fitted to the nut portion and clamps the filamentous material,
A medical treatment instrument, wherein a knot is provided on the proximal side of the filamentous material, and the knot is arranged on the proximal side of the contact surface described below in the distance direction of the filamentous material.
[conditions]
The fixing device has a contact surface whose normal vector has a component parallel to the advance direction of the bolt portion when the bolt portion is turned and advanced with respect to the nut portion in a state where the filamentous object is not sandwiched. In the above, the forward movement is restrained by direct contact or indirect contact between the first fixing member and the second fixing member .
However, the contact surface is a portion of the first fixing member other than the nut portion and a portion of the second fixing member other than the bolt portion. 2. The medical treatment instrument according to claim 1, wherein said filamentous material is made of a material containing fluororesin. the second fixing member has a large diameter portion provided adjacent to the bolt portion in the advancing direction of the bolt portion and having an outer diameter larger than the maximum outer diameter of the bolt portion;
The first fixing member has a recess that is provided adjacent to the nut portion in the advancing direction of the bolt portion and receives the large diameter portion,
The bottom surface of the recess of the first fixing member is directly or indirectly attached to the distal end surface or the proximal end surface of the large diameter portion of the second fixing member in a state where the fixing device does not clamp the filamentous object. The medical treatment instrument according to claim 1 or 2, which is in contact with. The inner peripheral surface of the recess of the first fixing member is in direct or indirect contact with the outer peripheral surface of the large-diameter portion of the second fixing member when the fixing device does not clamp the filamentous object. The medical treatment instrument according to claim 3. The medical treatment instrument according to any one of claims 1 to 4, wherein the knot does not contact the contact surface. The medical treatment instrument according to any one of claims 1 to 5, wherein the knot is held between the first fixing member and the second fixing member. The medical treatment instrument according to any one of claims 1 to 5 , wherein the knot exists outside the fixing device. When the bolt portion is fitted to the nut portion, the distal end of the first fixing member is arranged on the distal side of the distal end of the second fixing member in the far-near direction of the filament. The medical treatment instrument according to any one of claims 1 to 7. When the bolt portion is fitted to the nut portion, the distal end of the second fixing member is arranged on the distal side of the distal end of the first fixing member in the far-near direction of the filamentous member. The medical treatment instrument according to any one of claims 1 to 7. The medical treatment instrument according to any one of Claims 1 to 9, wherein the fixing device has an adhesion portion where the first fixing member and the second fixing member are adhered to each other. The medical treatment instrument according to any one of claims 1 to 10, wherein the advance direction of the bolt portion is parallel to the distance direction of the inner cylindrical body. 12. The first fixing member and the second fixing member are in contact with each other via a ring member on the contact surface in a state where the fixing device does not sandwich the filamentous object. The medical treatment tool according to the item. The treatment section is a clip that grips body tissue,
The clip has two clamping substrates,
The medical device according to any one of claims 1 to 12, wherein a fastener that has an outer diameter larger than the inner diameter of the inner cylindrical body and is axially movable is provided on the outside of the holding base material. Treatment tool. The medical treatment according to any one of claims 1 to 13, further comprising an outer cylinder that can accommodate the inner cylinder and the treatment section and that is movable in the far-near direction with respect to the inner cylinder. Treatment tool.

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