Medical ligature suture apparatus and medical ligature suture method

The present invention relates to a medical ligation and suturing device that is inserted into a body and ligates or sutures a living tissue.

In recent years, there has been an increase in treatment of living tissues in the body by oral endoscopy. For example, as a treatment for diseases such as gastroesophageal reflux disease in which the function of the sphincter muscle in the lower part of the esophagus is reduced and gastric acid flows back into the esophagus, a method of forming an artificial valve is known. Here, as a device for forming an artificial valve, there is a device for ligating and bulging a living tissue under observation with an endoscope (see, for example, Patent Document 1 and Patent Document 2).

The system disclosed in Patent Document 1 includes two needles that puncture a living tissue. A sheath is inserted into each needle so as to be able to move forward and backward. Further, a rod-shaped T-bar is loaded inside the vicinity of the tip of each needle. Sutures are fixed to these T-bars. When forming an artificial valve with living tissue, the living tissue is sucked and the swollen living tissue is punctured from the hand side to the back side with each needle. Then, push the T-bar out of the needle with a pusher tube and then pull out the needle. Then, two sutures penetrating the living tissue are tied, and this knot is pushed into the body with a general knot pusher and ligated at the hand side of the living tissue. Further, Patent Document 2 has two needle sliders, a pusher slider, and a housing, and has a needle operation portion integrally provided on the grip via a base member and an independent needle operation portion. A suture device including a provided ligator is disclosed.<patcit num="1"><text>Japanese Unexamined Patent Publication No. 2003-159254</text></patcit><patcit num="2"><text>U.S. Patent Application Publication No. 2003/236535</text></patcit>

<p> However, in this type of device, the suture must be tied outside the body after each needle is punctured, which is troublesome. Furthermore, it was necessary to separately facilitate the knot pusher for sending the knot, and it took time from the insertion of the suture into the living tissue to the ligation. Further, in the suturing device as disclosed in Patent Document 2, the ligature is provided independently of the needle body, so that the operability is not good. The present invention has been made in view of such circumstances, and an object of the present invention is to enable puncture of a living tissue into a sutured site and ligation after puncture by a series of operations.</p>

<p> The invention according to claim 1 of the present invention, which solves the above-mentioned problems, is inserted into a body cavity and provided with a tip insertion portion provided with at least one side opening, and is provided in the tip insertion portion and inserted into a living tissue. The holding member attached to the end of the ligating member is housed inside, and the pressing member that presses the holding member is inserted freely forward and backward, and the living tissue raised in the tip insertion portion can be penetrated from the side opening. A ligature body and a flexible ligation sheath that presses a stopper through which the ligature member is inserted toward the living tissue, and the stopper is attached to the tip of an operation wire that is freely inserted into the ligature sheath. The ligator is provided with an engaging portion that engages with the ligating member inserted into the ligature, and an operating portion provided on the proximal end side of the tip insertion portion. The operating portion is the proximal end of the tip inserting portion. A housing provided in the portion, a ligature handle provided in the housing so as to drive the needle body, a pressing handle provided in the housing and driven in the pressing member, and a pressing handle provided in the housing to drive the needle body. The medical ligation and suturing device is provided with a ligature that is freely provided to drive the ligature sheath and a ligature handle that is freely provided to the ligature to advance and retreat to drive the engaging portion. ..</p><p> This medical ligation and suturing device is used to ligate living tissue in a body cavity. The needle body containing the holding member is pierced from one side of the biological tissue to the other side, and the holding member is pushed out to the other side. A ligating member is attached to the holding member, and the ligating member penetrates the living tissue from one side to the other when the needle body is removed from the living tissue. Further, a stopper is provided on one side of the ligating member. Therefore, when the biological tissue is ligated so as to be sandwiched between the stopper and the holding member, the portion can be bulged. At this time, a puncture handle for advancing and retreating the needle body, a pressing handle for advancing and retreating the pressing member for pushing out the holding member, and a ligature and a ligation handle to be operated when ligating are provided in the housing so as to be freely accessible. You will be able to perform from puncture needle penetration to ligation by operating the side.</p><p> The invention according to claim 2 is the medical ligation and suturing device according to claim 1, wherein the operation unit has an interlocking device that interlocks the puncture handle and the pressing handle. In this medical ligation and suturing device, when the pressing handle is driven, the puncture handle is interlocked by the interlocking device, so that the pressing member and the needle body can be interlocked. When the puncture handle is driven, the pressing handle may be interlocked.</p><p> The invention according to claim 3 is the medical ligation and suturing apparatus according to claim 1, wherein the operation unit has an interlocking device that interlocks the ligation tool and the pressing handle. In this medical ligation and suturing device, when the pressing handle is driven, the ligature is interlocked by the interlocking device, so that the pressing member and the stopper can be interlocked. Therefore, it is possible to prevent tension from acting on the ligature member. The pressing handle may be interlocked when the ligator is driven.</p><p> The invention according to claim 4 is the medical ligation and suturing device according to claim 1, wherein the operation unit has an interlocking device that interlocks the ligation tool and the puncture handle. In this medical ligation and suture device, when the puncture handle is driven, the ligature is interlocked by the interlocking device, so that the needle body and the stopper can be interlocked. The puncture handle may be interlocked when the ligator is driven.</p><p> The invention according to claim 5 is the medical ligation and suturing device according to claim 1, wherein the operation unit includes an interlocking device for interlocking the puncture handle, the pressing handle, and the ligating tool. And. This medical ligation and suture device has an interlocking device, and when the puncture handle is driven, the pressing handle and the ligation tool are interlocked. Therefore, the pressing member and the stopper are interlocked with the movement of the needle body. The puncture handle and the ligator may be interlocked when the pressing handle is driven, or the puncture handle and the pressing handle may be interlocked when the ligating tool is driven.</p><p> The invention according to claim 6 is for pressing a puncture handle connected via a flexible sheath and a holding member attached to an end portion of the ligating member to a needle body for penetrating a ligating member through a living tissue. In addition, a pressing handle connected to a pressing member inserted into the needle body, a ligature connected to a ligating sheath that presses a stopper through which the ligating member is inserted, the puncture handle, the pressing handle, and the above. A medical ligature and suturing device including a housing in which each of the ligatures is freely attached and retracted, in which the ligature handle is most advanced from the initial position where the ligature handle is most retracted to penetrate the living tissue. A first interlocking device that interlocks and advances the puncture handle and the pressing handle until the transition to the puncture position, and releases the interlocking of the puncture handle and the pressing handle at the tissue perforation position, and the tissue. A medical ligature comprising a second interlocking device that engages the ligature with the pressing handle before reaching the penetration position and advances the ligature in conjunction with the pressing handle. It was a ligature device.</p><p> In this medical ligation and suturing device, the puncture handle and the pressing handle are interlocked while the puncture handle is moved from the first position to the second position and the needle body is inserted into the living tissue, so that the needle body and the pressing member are linked. Can move forward together. Further, the pressing handle and the ligator are interlocked while the puncture handle is moving to the second position. Therefore, for example, by operating the pressing handle, the puncture handle and the ligator are indirectly operated. That is, the medical ligation and suturing device can be operated by operating only one place, and the position of each part is appropriately controlled according to the stage of treatment.</p><p> The invention according to claim 7 is the medical ligation and suturing device according to claim 6, wherein the second interlocking device advances the pressing handle beyond the tissue penetration state and moves the holding member from the needle body. It is characterized in that the ligator is advanced in conjunction with the pressing handle until it is pushed out. In this medical ligation and suture device, when the holding member is pushed out from the needle body, the ligating tool advances in conjunction with the pressing member, and the stopper also advances.</p><p> The invention according to claim 8 is the medical ligation and suturing device according to claim 6, wherein the second interlocking device makes the pressing handle and the ligating tool independent in a direction in which the pressing handle is retracted. It is characterized by being a device that advances and retreats to. In this medical ligation and suturing device, when the pressing handle is retracted, the ligature is interlocked and does not retract.</p><p> In the invention according to claim 9, the ligating member is inserted into the living tissue by penetrating the living tissue through the needle body, and the holding member and the stopper attached to the ligating member so as to sandwich the living tissue are described above. In ligating the living tissue, the needle body containing the holding member is advanced toward the living tissue, and the needle body is interlocked with the needle body until the needle body penetrates the living tissue. , The step of advancing the stopper toward the living tissue, and after the needle body has penetrated the living tissue, the pressing member inserted into the needle body is advanced and accommodated in the needle body. After the step of pushing out the holding member and the needle body being removed from the living tissue, the ligation member inserted through the stopper is pulled, and the living tissue is sandwiched between the stopper and the holding member. A medical ligating and suturing method characterized by having a ligating step and a ligating step. This medical ligation and suture method is a method of ligating a living tissue in a body cavity. By penetrating the needle body containing the holding member from the proximal end side to the distal end side of the living tissue, the holding member is placed on the distal end side, and after the needle body is removed, the stopper on the proximal end side is used. The living tissue is ligated so as to sandwich the living tissue with the holding member, and the portion is bulged.</p><p> The invention according to claim 10 has the step of advancing the stopper in conjunction with the advancement of the pressing member after the needle body has penetrated the living tissue in the medical ligation and suturing method according to claim 9. It is characterized by that. In this medical ligation and suture method, the pressing member and the stopper are moved forward in an interlocking manner to prevent excessive tension from acting on the ligating member between the holding member and the stopper.</p><p> According to the eleventh aspect of the present invention, in the medical ligation and suturing method according to the tenth aspect, when the needle body is removed from the living tissue, the needle body is retracted in conjunction with the retreat of the pressing member. It is characterized by having a step. In this medical ligation and suturing method, the needle body is retracted in conjunction with the retracting of the pressing member to prevent the pressing member from being left in the living tissue.</p><p> According to a twelfth aspect of the present invention, in the medical ligation and suturing method according to the ninth aspect, when the needle body is removed from the living tissue, the needle body is retracted independently of the stopper. It is a feature. In this medical ligation and suturing method, when the needle body and the pressing member are interlocked and retracted, the stoppers are interlocked so as not to retract. This facilitates ligation after the needle body has been removed.</p>

<p> According to the present invention, when the ligating member is inserted into the living tissue and the ligation is performed, the means used for ligation can be operated by the operation unit, so that the treatment becomes easy. In addition, since the operation unit can be integrated at the time of use, handling becomes easy. Further, if any two or more of the needle body, the pressing member, and the ligature are operated in conjunction with each other, the operation in the operation unit can be simplified.</p>

The best mode for carrying out the invention will be described in detail with reference to the drawings. (First Embodiment) As shown in FIGS. 1 and 2, the medical ligation and suturing device 1 includes an operation unit 2 operated by a practitioner, and can be attached to the tip of the housing 3 of the operation unit 2. A flexible tube 4 is attached. An endoscope insertion portion 5 is fixed to the tip of the tube 4, from which the endoscope 6 can be inserted. A flexible overtube 7 which is a tip insertion part inserted into the body cavity is attached to the tip of the endoscope insertion part 5. Then, in the overtube 7, the insertion portion 11 of the puncture needle 10 which is a treatment tool as shown in FIGS. 3 and 4 and the insertion portion 42 of the ligature 40 as shown in FIG. 6 are from the housing 3 side. It has been inserted.

As shown in FIGS. 3 and 4, the insertion portion 11 of the puncture needle 10 has a flexible inner sheath 12 and a pusher 13 which is a pressing member that is freely inserted and retreated into the inner sheath 12. There is. The needle body 14 is fixed to the tip of the inner sheath 12. The needle body 14 has a cylindrical shape, and the tip opening 15 thereof is cut diagonally. As shown in FIG. 3, a slit 16 is provided along the length direction from the edge of the tip opening 15. A holding member 17 is housed in the needle body 14. The holding member 17 is attached to the end of the ligature thread (ligature member) 18 and is sometimes called a T-bar. The ligature thread 18 is pulled out of the needle body 14 from the slit 16. The pusher 13 is inserted through the inner sheath 12 in order to push the holding member 17 and the ligature thread 18 out of the needle body 14. The puncture needle 10 includes two inner sheaths 12 and two needle bodies 14 in parallel.

The insertion portion 11 including the two pushers 13 and the two inner sheaths 12 is connected to the operation unit 19 of the puncture needle 10. The operation unit 19 has a puncture handle 20 to which the inner sheath 12 is fixed. The puncture handle 20 has a substantially cylindrical shape, and as shown in FIG. 3, a groove 21 is formed on the outer peripheral surface thereof along the length direction from the tip portion to the base end portion. ing. Further, the base end portion of the puncture handle 20 is enlarged in the radial direction so that the practitioner can easily grasp the puncture handle 20. A connecting pin 23 constituting the first interlocking device is inserted in the enlarged diameter portion 22. The connecting pin 23 passes through the center of the enlarged diameter portion 22, and its base portion 23a is urged toward the upper side (upper side) in FIG. 3 by an elastic member 24 such as a coil spring. The tip portion 23b of the connecting pin 23 partially protrudes from the diameter-expanded portion 22. An intermediate portion 23c is formed between the base portion 23a and the tip portion 23b of the connecting pin 23, and the diameter of the intermediate portion 23c is smaller than that of the base portion 23a. Further, the puncture handle 20 is provided with a slide hole 25 recessed from the base end surface toward the tip end portion. The slide hole 25 communicates with two through holes 26 provided at the tip of the puncture handle 20. The two through holes 26 are provided in parallel, and the diameter of each of the two through holes 26 is sized so that each of the two pushers 13 can be inserted and retracted freely. Further, on the side portion of the puncture handle 20, slits 27 communicating with the slide hole 25 are provided in parallel in the length direction of the puncture handle 20. Two slits 27 are provided at positions that are 180 degrees out of phase. The two slits 27 are provided along a plane orthogonal to the connecting pin 23.

A pressing handle 30 is inserted into the slide hole 25 of the puncture handle 20 so as to be able to move forward and backward. The pressing handle 30 has a substantially columnar slide portion 31, and the handle body 32 is fixed to the base end of the slide portion 31. The slide portion 31 has an outer diameter that allows sliding contact with the slide hole 25, and a guide member 33 is fixed to the tip thereof. The guide member 33 slides in the slit 27 of the puncture handle 20, and two pushers 13 are fixed in parallel to the tip thereof. Further, the slide portion 31 is provided with slits 34 in parallel in the length direction. The slit 34 penetrates the slide portion 31 up and down, and the intermediate portion 23c of the connecting pin 23 is inserted into the slit 34. The width of the slit 34 is narrower than the base 23a of the connecting pin 23. However, a part of the lower side of the tip portion of the slit 34 is cut out so as to be engaged with the base portion 23a of the connecting pin 23. The handle body 32 has a larger diameter than the slide portion 31, and an interlocking member 35 is fixed to the upper portion thereof. The interlocking member 35 is provided with a contact surface 36 that abuts and engages with the finger hook portion 52 of the ligature 40, which will be described later, and serves as a second interlocking device.

As shown in FIG. 5, the ligator 40 has an operation unit 41 which is a ligation portion, and a flexible insertion portion 42 is provided at the tip of the operation unit 41. In the insertion portion 42, the operation wire 44 is inserted into the ligature sheath 43 so as to be able to advance and retreat. A hook 45, which is an engaging portion that can be engaged with the ligature thread 18, is attached to the tip of the operation wire 44. As shown in FIG. 6, a stopper 47 is arranged at the tip of the ligature sheath 43 via a cutter receiving portion 46. As shown in FIG. 5, the operation unit 41 of the ligator 40 has a substantially cylindrical main body 50. The base end of the ligature sheath 43 is fixed to the tip of the main body 50. Further, a knob portion 51 is fixed to the tip portion of the main body portion 50. The knob portion 51 is where the practitioner grasps when operating the ligation handle 55, which will be described later. A finger hook 52 is attached to the base end of the main body 50. The base end of the finger hook portion 52 is a flat surface 53, and the flat surface 53 is brought into contact with the contact surface 36 of the interlocking member 35. Further, the main body 50 is provided with a slit 54 parallel to the length direction thereof. The slit 54 penetrates the main body 50 up and down, and the ligation handle 55 is slidably attached to the slit 54. A base end portion of an operation wire 44 for freely advancing and retreating the main body 50 is fixed to the ligation handle 55.

The cutter receiving portion 46 shown in FIG. 6 is a cylindrical member whose base end portion abuts on the ligature sheath 43. A through hole 56 is provided in the side wall portion of the cutter receiving portion 46. Two through holes 56 are arranged along the length direction of the cutter receiving portion 46 in a side view, and two are similarly arranged at positions that are 180 degrees out of phase, so that a total of four through holes 56 are provided. A ligature thread 18 pulled out through the stopper 47 is inserted into the cutter receiving portion 46. The ligature thread 18 is inserted through the through hole 56 on the tip side outward from the opening at the tip end portion of the cutter receiving portion 46, passes through the outer peripheral surface of the cutter receiving portion 46, and then passes through the through hole 56 on the proximal end side. It is inserted inward and introduced into the ligature sheath 43 through the opening at the base end. The stopper 47 is manufactured of silicone resin or the like, and an intermediate portion of a ligature thread 18 whose both ends are attached to a holding member 17 is inserted. The stopper 47 is used for frictionally engaging with the ligature thread 18 and ligating the living tissue together with the holding member 17 (see FIG. 3).

Here, as shown in FIGS. 1 and 7, in this embodiment, the ligature 40 is provided with a cutter 60 that cuts the ligature thread 18 in the body cavity. The cutter 60 has a flexible cutter sheath 61 that covers the outer periphery of the ligature sheath 43 so as to be able to move forward and backward. The tip position of the cutter sheath 61 substantially coincides with the tip position of the ligature sheath 43. A cutter portion 62 is fixed to the tip of such a cutter sheath 61. The cutter portion 62 covers the outer peripheral surface of the cutter receiving portion 46 on the base end side, and its inner diameter is substantially equal to the outer diameter of the cutter receiving portion 46. As shown in FIG. 8, the cutter portion 62 is provided with two notches 63 at positions shifted by 180 ° in phase. Each notch 63 has a base end at the opening 62a at the tip, extends from there along the length direction of the cutter portion 62, and is oriented in the circumferential direction in the vicinity of approximately the middle of the length direction, in the circumferential direction. It extends along and then folds back towards the periphery of opening 62a. A blade portion 65 is formed at the folded end portion. As shown in FIG. 7, as an initial state, the cutter portion 62 is arranged at a position where the end portion of the notch 63 and the through hole 56 on the proximal end side of the cutter receiving portion 46 communicate with each other. Then, the ligature thread 18 is routed so that the portion of the portion inserted through the cutter receiving portion 46 that passes through the outer peripheral surface of the cutter receiving portion 46 is hooked on the shoulder portion 66 formed by the notch 63. To. That is, the ligature thread 18 is pulled out from the through hole 56 on the tip end side of the cutter receiving portion 46, passes through the outer peripheral surface of the shoulder portion 66 of the cutter portion 62, and passes through the through hole 56 from the end portion of the notch 63 to receive the cutter. It is inserted into the part 46. Further, as shown in FIG. 1, the base end of the cutter sheath 61 is fixed to a cutter handle 68 attached to the upper part of the housing 3 (upper side in FIG. 1) so as to be able to advance and retreat.

Next, the housing 3 to which the operation unit 19 of the puncture needle 10 and the operation unit 41 of the ligature 40 are mounted will be described. As shown in FIG. 9, the housing 3 is provided with an accommodating portion 70 into which the operation unit 19 is freely inserted and retracted on the base end side and below the housing 3. The accommodating portion 70 has a substantially rectangular parallelepiped shape, and a substantially cylindrical insertion hole 71 is formed inside the accommodating portion 70. A tapered surface 71a is formed at the base end of the insertion hole 71 so as to increase its diameter. The puncture handle 20 (see FIG. 3) is inserted into the insertion hole 71. A through hole 72 is formed at the tip of the accommodating portion 70 to communicate the tip surface of the accommodating portion 70 with the insertion hole 71. Two through holes 72 are formed in parallel, and an inner sheath 12 is inserted into each of them so as to be able to advance and retreat. Further, a daylighting window 74 is formed on each side wall portion 73 of the accommodating portion 70. An engaging screw 76 is screwed into the base end side of the bottom portion 75 of the accommodating portion 70. Further, a grip 77 is attached to the bottom 75 of the accommodating portion 70. The grip 77 extends diagonally forward (the tip end side and the lower side of the housing 3) from the housing portion 70.

Further, the housing 3 is provided with a slide receiving portion 78 on the accommodating portion 70. The slide receiving portion 78 extends toward the tip end side of the accommodating portion 70. As shown in FIGS. 9 and 10, the slide receiving portion 78 has a substantially C-shaped cross section so that the upper portion thereof is the open end 79. Further, on the base end side of the slide receiving portion 78, the vicinity of the open end 79 is cut out. The notch 80 forms an abutting portion 81 in which the distance between the open ends 79 gradually increases. As shown in FIG. 9, a housing tip portion 82 is provided at the tip of the slide receiving portion 78. An outer sheath 83 and two outer sheaths 84 arranged in parallel are inserted through the housing tip portion 82. The outer sheath 83 is fixed to the housing tip 82 so that the opening at the base end communicates with the slide receiving portion 78. The two outer sheaths 84 are pulled downward from the housing tip 82 and are fixed to each other so as to cover each through hole 72 of the housing 70.

As shown in FIG. 11, each outer sheath 83, 84 is inserted into the tube 4 fixed to the tip of the housing 3 and guided into the over tube 7 shown in FIG. The overtube 7 has a substantially cylindrical tube body 90 and a detachable tip tube 91 at the tip of the tube body 90. The tip tube 91 is a dome portion 93 in which the tip of the cylindrical portion is closed in a dome shape. A slit 94 is provided in the dome portion 93, and the dome portion 93 is divided into a plurality of valve bodies. Further, the cylindrical portion 92 is formed with an elongated hole along the circumferential direction, which serves as a side opening 95 for sucking living tissue. As shown in FIGS. 12 and 13, an engaging portion 96 is provided at the base end of the cylindrical portion 92. The engaging portion 96 has a screw engraved on the outer peripheral surface of the annular member. Further, as shown in FIG. 13, two positioning pins 97 extend in parallel in the axial direction from the engaging portion 96.

In the tube body 90, the tips of the outer sheaths 83 and 84 are tied and fixed to the inner wall on the proximal end side by a predetermined distance from the tip opening 90a with a thread 98. The positions of the tips of the outer sheaths 83 and 84 are positions that do not interfere with the operation of the puncture needle 10 and the ligature tool 40, which will be described later, and it is difficult to apply an adhesive to such positions. Thread 98 is used as a ligature. Further, a receiving portion 99 that engages with the pin 97 is recessed in the tip opening 90a of the tube body 90. Further, an annular groove 100 is formed on the outer periphery in the vicinity of the tip opening 90a, and the annular protrusion 102 of the rotating ring 101 is accommodated in the groove 100. The rotary ring 101 is rotatably mounted so as to cover the outer periphery of the tube body 90. The tip of the rotating ring 101 protrudes from the tube body 90, and a screw is engraved on the inner peripheral surface of the protruding portion. This screw can be engaged with the screw of the engaging portion 96 on the tip tube 91 side.

The operation of this embodiment will be described. As shown in FIG. 14, when the puncture needle 10 is attached, each needle body 14 is inserted into each of the two through holes 72 of the accommodating portion 70 of the housing 3. Positioning of each needle body 14 with respect to the through hole 72 is performed while utilizing the light guided into the accommodating portion 70 from the lighting window 74 formed in the side wall portion 73. After inserting each needle body 14 into the accommodating portion 70, the inner sheath 12 is fed, and each needle body 14 and each inner sheath 12 are fed from the accommodating portion 70 into each outer sheath 84. Further, the operation unit 19 is inserted into the accommodating portion 70. At this time, the groove 21 of the puncture handle 20 and the screw hole of the engaging screw 76 of the accommodating portion 70 are inserted so as to coincide with each other. The tip is projected into the groove 21. As a result, the puncture handle 20 can move forward and backward with respect to the housing 3 from the base end to the tip end of the groove 21, and the puncture handle 20 is prevented from falling off. At this time, the two needle bodies 14 project from the outer sheath 84 in the overtube 7 (see FIG. 1) and are arranged at the first position near the side opening 95.

When attaching the ligature 40, the insertion portion 42 is inserted into the cutter sheath 61, and then the cutter sheath 61 is inserted into the outer sheath 83. Further, the main body 50 of the cutter handle 68 and the operation unit 41 is inserted into the slide receiving portion 78 of the housing 3. The ligator 40 can advance and retreat from the initial position shown in FIGS. 2 and 15 to the advancing position as shown in FIG. This forward position is a position where the abutting portion 81 and the finger rest portion 52 come into contact with each other. As shown in FIG. 17, when the puncture needle 10, the ligature 40, and the cutter 60 are attached, the position of each part at this time becomes the initial position (corresponding to the first position). In the overtube 7, the tip of the insertion portion 42 is arranged on the proximal end side by a predetermined distance from each needle body 14.

When attaching the two holding members 17 to which the ligature thread 18 is attached to each needle body 14, the tip tube 91 of the overtube 7 is removed as shown in FIG. At this time, the tip tube 91 and the tube body 90 are held, and the rotary ring 101 is rotated. After removing the tip tube 91, the holding member 17 is inserted through the opening of each needle body 14, and the ligature thread 18 is pulled out from the slit 16 (see FIG. 3) of the needle body 14. Further, as shown in FIG. 6, when the stopper 47 and the cutter receiving portion 46 are attached to the ligature tool 40, the ligature handle 55 shown in FIG. 5 is advanced toward the tip side to expose the hook 45 from the ligature sheath 43. .. Then, as shown in FIG. 6, the ligature thread 18 looped by the stopper 47 and the cutter receiving portion 46 is hooked on the hook 45, and then the hand is released from the ligature handle 55. Since a spring (not shown) is inserted between the ligature handle 55 and the knob 51, the ligature handle 55 automatically returns to the initial position, and the hook 45 and the ligature thread 18 engaged with the hook 45 Is drawn into the ligature sheath 43. As a result, the cutter receiving portion 46 and the stopper 47 are held in this order at the tip of the ligature sheath 43.

When ligating a living tissue, the endoscope 6 is inserted from the endoscope insertion portion 5 shown in FIG. 1, and the overtube 7 is inserted into the body cavity. When the side opening 95 of the overtube 7 reaches the site to be ligated (target site), the suction means (not shown) of the endoscope 6 is operated to suck the target site from the side opening 95 into the overtube 7. To do. As a result, as shown in FIG. 18, the biological tissue W1 is sucked into the overtube 7. After sucking the biological tissue W1, the practitioner pushes the pressing handle 30 toward the tip side and advances each needle body 14 toward the biological tissue W1. At this time, since the pressing handle 30 and the puncturing handle 20 are connected by the connecting pin 23, the puncturing handle 20 advances in conjunction with the pressing handle 30, and as a result, each inner sheath 12 and each pusher 13 Move forward at the same time. In FIG. 18, since the ligature 40 is not operated, the stopper 47 does not move forward.

When the pressing handle 30 is further pushed in, as shown in FIG. 19, the interlocking member 35 of the pressing handle 30 abuts and engages with the finger hook portion 52 of the operation unit 41. As a result, the pressing handle 30 and the operating unit 41 are engaged, and when the pressing handle 30 is advanced, the ligator 40 and the puncture handle 20 are interlocked and advanced, and the distance between the holding member 17 and the stopper 47 is substantially constant. Is kept in.

Then, as shown in FIG. 20, when the needle body 14 reaches the position (second position) through which the biological tissue W1 is penetrated, most of the puncture handle 20 enters the accommodating portion 70. At this time, the connecting pin 23 is immersed in the puncture handle 20 by the tapered surface 71a of the insertion hole 71. As a result, the connection between the pressing handle 30 and the puncture handle 20 is released. The operation up to this point is the same even when the puncture handle 20 is advanced instead of the pressing handle 30. Even after each needle body 14 reaches the second position, when the pressing handle 30 is pushed in, the puncture handle 20 remains stopped because the connection is released, so that the pusher 13 advances with respect to the needle body 14. To do. As a result, as shown in FIG. 21, each holding member 17 in each needle body 14 is extruded and released to one side of the biological tissue W1. Further, since the interlocking state with the ligator 40 is maintained, the ligator 40 advances in conjunction with the pressing handle 30, and the stopper 47 approaches the other side portion of the biological tissue W1. The position of the pressing handle 30 and the pusher 13 and the position of the ligator 40 at this time are set as the third position.

After pushing out each holding member 17 from the needle body 14, the pressing handle 30 is pulled back. In the backward direction, since the interlocking member 35 and the finger hook portion 52 are disengaged, only the pressing handle 30 is pulled back, and the pusher 13 is housed in the needle body 14. When the pressing handle 30 is pulled back by a predetermined amount, the tip of the slit 34 (see FIG. 4) engages with the connecting pin 23, and the puncture handle 20 is pulled by the pressing handle 30 to start retreating. At this time, the connecting pin 23 pressed against the tapered surface 71a gradually pops out, and the pressing handle 30 and the puncture handle 20 are connected. As a result, the puncture handle 20 is pulled back in conjunction with the pressing handle 30, and the pusher 13 and the needle body 14 retract at the same time. Then, as shown in FIG. 22, when the pressing handle 30 is pulled back to the initial position, the puncture handle 20 is also pulled back to the initial position, and during this time, each needle body 14 is pulled out from the living tissue W1. The holding member 17 is placed on one side of the living tissue W1, and the ligature thread 18 is inserted so as to penetrate both sides of the living tissue W1.

Next, the ligator 40 shown in FIG. 5 is operated to ligate the biological tissue W1 with the holding member 17 and the stopper 47. First, the ligation handle 55 is pulled back along the slit 54. The operating wire 44 fixed to the ligature handle 55 retracts and the hook 45 pulls the ligature thread 18. As a result, as shown in FIG. 23, the holding member 17 attached to the end of the ligature thread 18 is attracted to the stopper 47 side and pressed against one side of the biological tissue W1. Since the position of the stopper 47 does not move, the biological tissue W1 is ligated so as to be sandwiched between the holding member 17 and the stopper 47. After ligating the biological tissue W1, the excess ligature thread 18 is cut. That is, the cutter handle 68 shown in FIG. 24 is pulled to retract the cutter sheath 61. The cutter portion 62 retracts, the blade portion 65 moves so as to close the through hole 56, and the ligature thread 18 is cut as shown in FIG. 25. After that, after stopping the suction by the endoscope 6, the overtube 7 is pulled out from the body cavity to end the procedure. As shown in FIG. 26, the biological tissue W1 is ligated by two holding members 17 and a stopper 47 to maintain a swollen state.

According to this embodiment, an operation unit including a puncture needle 10 for penetrating the biological tissue W1 and a ligature 40 for ligating the biological tissue W1 through which the ligature thread 18 is inserted, and having handles 20, 30 and 55, respectively. Since 41 is provided integrally, one practitioner can operate it. In particular, since the puncture needle 10 and the ligator 40 can be operated in conjunction with each other, the operation becomes easy. Further, when the puncture needle 10 is pierced, each needle body 14, each pusher 13, and the ligature 40 are interlocked with each other, so that the ligature thread 18 is not pulled and the ligature thread 18 is surely attached to the biological tissue W1. Can be inserted into. Further, between the first position and the second position, the pressing handle 30 and the puncture handle 20 are connected by the connecting pin 23 which is the first connecting device, and when one of the handles 20 and 30 is moved forward and backward, the other is used. Since the handles 20 and 30 are moved forward and backward in the same direction and the connection is released at the second position, the puncture needle 10 can be advanced and the holding member 17 thereafter can be moved with a simple configuration and with one operation. You will be able to extrude. Further, when the pressing handle 30 is advanced, the interlocking member 35, which is the second interlocking device, engages with the ligature 40 between the first position and the second position, so that the configuration is simple. The ligator 40 can be interlocked. Therefore, the ligature 40 can be advanced by simply operating the pressing handle 30. This interlocking operation continues until the pressing handle 30 reaches the third position. The interlocking member 35 also has a role of preventing the ligator 40 from coming out of the slide receiving portion 78.

By using the engaging screw 76, the operation unit 19 is detachably configured in the housing 3, and the movement amount of the operation unit 19 is controlled, it is prevented from coming off, and the rotation is prevented. 19 will be easier to handle. Since the abutting portion 81 is formed by the notch provided in the slide receiving portion 78 and the abutting portion 81 is used as a stopper in the forward direction of the ligature 40, the amount of advance of the ligature 40 can be controlled with a simple configuration. be able to. Since the grip 77 of the housing 3 is tilted diagonally forward, it is easy to apply force when advancing each handle 20, 30, 55, 68 or the ligature 40. Since the pin 97 is provided on the tip tube 91 of the overtube 7, the tip tube 91 can be connected so that the side opening 95 and the needle body 14 are always in a constant direction. Then, when the treatment is performed using such a medical ligation and suture device 1, the biological tissue W1 can be ligated quickly and reliably.

In FIG. 13, the pin 97 is provided in the engaging portion 96 of the tip tube 91, but the receiving portion is recessed in the engaging portion 96, and the engaging projection that engages with the receiving portion is provided in the tube body 90. It may be provided in. The engaging protrusion in this case can also be used as a guide member for guiding the advance / retreat of the needle body 14. Further, in this embodiment, in order to facilitate the attachment of the holding member 17 and the like, the tip tube 91 of the overtube 7 is detachable from the tube body 90 by using the rotating ring 101, but other components are involved. Combined means may be used. For example, as shown in FIG. 27, a saw blade-shaped protrusion 120 is provided in an annular shape on the outer periphery of the base end portion of the tip tube 91, and the inner peripheral surface of the tip opening of the tube body 90 is engaged with the protrusion 120. A section 121 is provided. When the protrusion 120 is made of an elastically deformable member, the tip tube 91 can be attached and detached simply by pulling or pushing it in the axial direction. Further, as shown in FIG. 28, a reduced diameter portion 130 may be provided at the base end portion of the tip tube 91, and a protrusion 131 may be provided at one location on the outer periphery of the reduced diameter portion 130. A part of the tip opening 90a of the tube main body 90 is extended in the axial direction to form an extension portion 132, and one end of a rubber belt 133 is fixed to the extension portion 132. An engaging member 134 is fixed to the other end of the rubber belt 133, and the engaging member 134 is provided with a hole 135 for engaging with the protrusion 131. As shown in FIG. 29, with the tip tube 91 attached to the tip opening of the tube body 90, the rubber belt 133 is wound around the outer peripheral surface of the reduced diameter portion 130, and the hole 135 and the protrusion 131 are engaged with each other to engage the tip. Fix the tube 91 to the tube body 90. In this case, the tip tube 91 can also be positioned in the rotational direction.

(Second Embodiment) The second embodiment of the present invention will be described with reference to the drawings. The same components as those in the first embodiment are designated by the same reference numerals. Further, the description overlapping with the first embodiment will be omitted. As shown in FIG. 30, the medical ligation and suture device 201 has an operation unit 202. An overtube 7 is attached to the tip of the operation unit 202 via a tube 4 and an endoscope insertion unit 5 (see FIG. 1). The operation unit 202 has a housing 3, and an operation unit 219 of the puncture needle 210 is mounted on the accommodating unit 70 of the housing 3 so as to be able to move forward and backward. Further, the operation unit 41 of the ligator 40 is mounted on the slide receiving portion 78 so as to be able to move forward and backward. Here, in the operation unit 219, the pin 223 is fixed in the enlarged diameter portion 222 on the base end side of the puncture handle 220. The pin 223 is arranged in the slit 34 of the pressing handle 230 and can be engaged with the tip portion 230a of the pressing handle 230. Further, the pressing handle 230 can move forward and backward independently of the ligator 40. The other configuration of the medical ligation suture device 201 is the same as that of the first embodiment.

When ligating the biological tissue W1 with this medical ligation and suturing device 201, the biological tissue W1 is sucked into the overtube 7 in the body cavity. After that, as shown in FIG. 31, the operation unit 41 of the ligature tool 40 is advanced, the ligature sheath 43 is advanced, and the stopper 47 is brought close to the biological tissue W1. As a result, the distance between the stopper 47 and each holding member 17 is reduced. Next, the puncture handle 220 is advanced, and the two needle bodies 14 at the tips of the inner sheaths 12 are advanced at the same time. At this time, since the pressing handle 230 is engaged with the pin 223, it advances together with the puncture handle 220, and the pusher 13 also advances by the same distance as the needle body 14. Therefore, the pin 223 functions as a means for interlocking the pressing handle 230 while advancing the puncture handle 220 from the first position to the second position.

Then, when the tip of each needle body 14 penetrates the biological tissue W1 and reaches the second position, the hand is released from the puncture handle 220 and the pressing handle 230 is advanced. As shown in FIG. 32, each pusher 13 pushes two holding members 17 out of each needle body 14. After that, the pressing handle 230 is returned to the initial position, and then the puncture handle 220 is returned to the initial position (see FIG. 33). As a result, each pusher 13 is pulled back, and each pusher 13 and each needle body 14 are pulled out from the biological tissue W1. Then, with the main body 50 of the operation unit 41 fixed, the ligature handle 55 is retracted, the ligature thread 18 is pulled by the hook 45, and the living tissue W1 is sandwiched between the holding member 17 and the stopper 47 to ligate. After ligation, the cutter handle 68 (see FIG. 24) is retracted to cut off excess ligature thread 18.

In this embodiment, since the ligator 40 that operates in the body cavity and in the vicinity of the living tissue W1 is provided, the procedure from puncture to ligation can be performed quickly. Further, since the needle body 14 of the puncture needle 210, the pusher 13, the ligature sheath 43 of the ligature tool 40, and the hook 45 can be moved forward and backward independently, the degree of freedom of operation is increased.

(Third Embodiment) The third embodiment of the present invention will be described with reference to the drawings. The same components as those in each of the above-described embodiments are designated by the same reference numerals. Further, the description overlapping with each of the above-described embodiments will be omitted. As shown in FIG. 34, in the operation unit 302 of the medical ligation and suture device 301, the operation unit 319 of the puncture needle 310 is inserted into the accommodating portion 70 of the housing 3. The operation unit 319 includes a connecting pin 23 that engages and interlocks the puncture handle 20 and the pressing handle 330, but the pressing handle 330 and the ligator 40 advance and retreat independently. Note that FIG. 34 shows a state in which the ligature tool 40 is pushed in by a predetermined amount. Further, other components of the medical ligation and suturing device 301 are the same as those in the first embodiment.

When ligating the biological tissue W1 with this medical ligation suture device 301, after sucking the biological tissue W1 into the overtube 7 in the body cavity, the ligator 40 is advanced and the stopper 47 is tipped from the needle body 14. On the side, advance to a position close to the side opening 95. Next, the pressing handle 330 is advanced. Since the puncture handle 20 is connected to the pressing handle 330 by the connecting pin 23, each needle body 14 advances toward the biological tissue W1 together with each pusher 13. As shown in FIG. 35, when each needle body 14 reaches the second position penetrating the biological tissue W1, the connecting pin 23 moves and the connection between the pressing handle 330 and the puncture handle 20 is released. Only the pressing handle 330 advances. Then, as shown in FIG. 36, each pusher 13 pushes each holding member 17 out of each needle body 14 at the position where the pressing handle 330 is most advanced. During this period, the ligator 40 remains stationary. After that, when the pressing handle 330 is pulled back, only the pressing handle 330 retracts to the second position where the connecting pin 23 operates, and after the second position, the puncture handle 20 retracts in conjunction with the pressing handle 330. In this way, each needle body 14 is pulled out, the ligature thread 18 is passed through the living tissue W1, the ligature handle 55 is retracted, the living tissue W1 is ligated, and an extra ligature is made with the cutter handle 68 (see FIG. 24). Cut the thread.

In this embodiment, since the ligator 40 that operates in the body cavity and in the vicinity of the living tissue W1 is provided, the procedure from puncture to ligation can be performed quickly. Further, when penetrating the living tissue W1 and when removing the needle body 14 from the living tissue W1, the needle body 14 of the puncture needle 310 and the pusher 13 can be interlocked with each other. It becomes possible to do it, and the operability is improved.

(Fourth Embodiment) The fourth embodiment of the present invention will be described with reference to the drawings. The same components as those in each of the above-described embodiments are designated by the same reference numerals. Further, the description overlapping with each of the above-described embodiments will be omitted. As shown in FIG. 37, in the operation unit 402 of the medical ligation and suture device 401, the operation unit 419 of the puncture needle 410 is inserted into the accommodation unit 70 of the housing 3. In the operation unit 419, the puncture handle 420 and the pressing handle 430 can be moved forward and backward independently. Further, an interlocking device 460 for connecting the puncture handle 420 and the ligator 440 is provided. The interlocking device 460 extends downward from the engaging claw 462 extending from the upper portion of the support portion 461 attached to the enlarged diameter portion 222 of the puncture handle 420 along the tip direction and the finger hook portion 452 of the operation unit 441. It consists of an engaged portion 463. As shown in FIG. 38, two engaging claws 462 are provided in parallel. Each of them can be elastically deformed, and its tip is bent so as to be close to each other. The engaged portion 463 has a width and a length that can be engaged with the engaging claw 462. The other components of the medical ligation and suture device 401 are the same as those in the first embodiment.

In this medical ligation and suturing device 401, as an initial state, the puncture handle 420 is pulled out so that the engaging claw 462 comes behind the engaged portion 463 of the ligating tool 440. When the puncture handle 420 is advanced, the pressing handle 430 is also advanced accordingly, and as a result, the needle body 14 and the pusher 13 are advanced at the same time. Here, as shown in FIGS. 39 and 40, when the puncture handle 420 advances by a predetermined length, the engaging claw 462 and the engaged portion 463 are engaged, and the puncture handle 420 and the ligator 440 are connected. To. The predetermined length is a distance such that excessive tension does not act on the ligature thread 18 between the holding member 17 and the stopper 47 in the needle body 14. When the puncture handle 420 is further advanced, each needle body 14, each pusher 13, the ligator 440, and the cutter 60 (see FIG. 1) are advanced at the same time. As shown in FIG. 41, at the position where the puncture handle 420 abuts on the accommodating portion 70, each needle body 14 penetrates the biological tissue W1. After this, when the pressing handle 430 is advanced, only each pusher 13 is advanced and each holding member 17 is pushed out. Next, the pressing handle 330 is returned. Further, after the connection between the puncture handle 420 and the ligator 440 is released, the puncture handle 420 is pulled back and each needle body 14 is removed from the biological tissue W1. Further, the ligature handle 55 is pulled to ligate the biological tissue W1, and the cutter portion 62 (see FIG. 24) cuts the excess ligature thread 18.

In this embodiment, since the ligator 440 that operates in the body cavity and in the vicinity of the living tissue W1 is provided, the procedure from puncture to ligation can be performed quickly. Further, by using the interlocking device 460, the puncture handle 420 and the ligator 440 can be easily and surely interlocked. Therefore, when penetrating the biological tissue W1, the needle body 14, the pusher 13, the ligature 440, and the cutter portion 62 can be interlocked by operating the puncture handle 420. It is possible to perform with one operation, and operability is improved. Further, when the needle body 14 that has been punctured by mistake is pulled out and re-punctured, the ligator 440 can be moved forward and backward by operating only the puncture handle 420, which facilitates the operation.

(Fifth Embodiment) The fifth embodiment of the present invention will be described with reference to the drawings. The same components as those in each of the above-described embodiments are designated by the same reference numerals. Further, the description overlapping with each of the above-described embodiments will be omitted. As shown in FIG. 42, the operation unit 502 of the medical ligation and suture device 501 includes an interlocking device 560 that connects the pressing handle 530 and the ligator 440. The interlocking device 560 includes an engaging claw 462 provided on the pressing handle 530 and a supporting portion 461 thereof, and an engaged portion 463 provided on the finger rest portion 452 of the operation unit 441. Other components are the same as in the fourth embodiment.

The medical ligation suture device 501 drives the pressing handle 530 by advancing the puncture handle 220, and advances each needle body 14 and each pusher 13. At this time, before the puncture handle 220 is accommodated in the accommodating portion 70, as shown in FIG. 43, the interlocking device 560 engages the pressing handle 530 and the ligator 440 and starts interlocking. Then, as shown in FIG. 44, when the puncture handle 220 is advanced to the third position, each holding member 17 is pushed out from each needle body 14, and the stopper 47 advances to a position close to the living tissue W1.

In this embodiment, since the ligator 440 that operates in the body cavity and in the vicinity of the living tissue W1 is provided, the procedure from puncture to ligation can be performed quickly. Further, by using the interlocking device 560, the pressing handle 530 and the ligator 440 can be easily and surely interlocked. Therefore, by operating the puncture handle 220 when penetrating the biological tissue W1, the needle body 14, the pusher 13, the ligator 440, and the cutter portion 62 can be interlocked with each other. It becomes possible to perform with one operation, and operability is improved.

(Sixth Embodiment) The sixth embodiment of the present invention will be described with reference to the drawings. The same components as those in each of the above-described embodiments are designated by the same reference numerals. Further, the description overlapping with each of the above-described embodiments will be omitted. As shown in FIG. 45, the operation unit 602 of the medical ligation and suture device 601 includes an interlocking device 560 that connects the pressing handle 530 and the ligator 440. Other components are the same as in the first embodiment.

In the medical ligation and suturing device 601, the pressing handle 530 is pulled out to the first position in the initial state, and the pressing handle 530 and the puncture handle 20 are connected by a connecting pin 23. Further, the engaged portion 463 of the ligator 440 is located on the tip side of the engaging claw 462 of the pressing handle 530, and both are independent. When ligating the biological tissue W1, the pressing handle 530 is first advanced. The puncture handle 20 advances in conjunction with the pressing handle 530, and each needle body 14 and each pusher 13 advance. Further, when the pressing handle 530 is pushed, the engaging claw 462 and the engaged portion 463 are engaged at a predetermined position, and the ligator 440 is connected to the pressing handle 530. The moving distance from the initial position of the pressing handle 530 to connecting to the puncture handle 20 is set within a range in which excessive tension does not act on the ligature 18 between each holding member 17 and the stopper 47. Then, as shown in FIG. 46, when the connecting pin 23 of the operating unit 619 fits within the accommodating portion 70 at the second position, the engagement between the pressing handle 530 and the puncture handle 20 is released. At this time, each needle body 14 penetrates the living tissue W1.

Further advancing the pressing handle 530 causes the ligator 440 to advance accordingly. As shown in FIG. 47, when the engaged portion 463 comes into contact with the base end surface of the accommodating portion 70, each pusher 13 pushes each holding member 17 out of each needle body 14. Next, the pressing handle 530 is pulled back while disengaging the engaged portion 463 and the engaging claw 462. As in the first embodiment, after only each pusher 13 retracts, the pressing handle 530 and the puncture handle 20 begin to interlock, and each pusher 13 and each needle body 14 are removed from the living tissue W1. Further operation of the ligature 440 and the cutter 60 (see FIG. 24) ligates the biological tissue W1 and cuts the excess ligature thread 18.

In this embodiment, the same effect as in the first embodiment can be obtained. Further, since the interlocking device 560 is provided to connect the ligator 440 and the pressing handle 530, the needle body 14 and the ligator 440 can be moved forward and backward integrally. Therefore, for example, when the holding member 17 or the like is attached, or when the penetration position is confirmed, the advancing / retreating operation can be easily performed.

Here, as shown in FIGS. 48 to 50, the medical ligation and suture device 601 can independently advance and retreat at least one of the puncture handle 20, the pressing handle 530, and the ligator 440. That is, in FIG. 48, only the ligator 440 is independently advanced, and the stopper 47 is first moved toward the side opening 95. In FIG. 49, the puncture handle 20 is advanced and only the needle body 14 is advanced without the interlocking device 560 acting. In FIG. 50, only the pressing handle 530 is advanced and only the pusher 13 is advanced to release the holding member 17 from the needle body 14 without the interlocking device 560 acting. Such an operation is performed, for example, when the holding member 17 is replaced or when the operation is checked.

The present invention is not limited to the above embodiments and can be widely applied. For example, the puncture needles 10,210,310,410 may have only one needle body 14. Each medical ligation and suture device 1,201,301,401,501,601 does not have to have a cutter 60. That is, the stopper 47 may be directly abutted against the tip of the ligature sheath 43. In this case, as shown in FIG. 51, the excess ligature thread 18 is cut using the forceps 6a inserted into the channel of the endoscope 6. At this time, if the ligature handle 55 is pushed in slightly to advance the hook 45, the ligature thread 18 is slackened and easily cut. As shown in FIG. 52, after cutting the ligature thread 18, the forceps 6a (see FIG. 49) is housed in the endoscope 6, the suction of the biological tissue W1 is stopped, and the overtube 7 is pulled out. Further, in each medical ligation and suturing device 1,201,301,401,501,601, each ligation tool 40,440 may be a ligation tool provided with a cutter 60.

In the medical ligation and suturing device 701 as shown in FIG. 53, the slide member 702 is slidably inserted into the slide receiving portion 78, and the ligator 40 is fixed to the upper portion of the slide member 702. This medical ligation and suture device 701 has the same configuration as the medical ligation and suture device 701 shown in FIG. 1, except that the ligation tool 40 is a separate axis. Further, the slide member 702 may be detachably configured in the housing 3 as in the medical ligation and suturing device 801 shown in FIG. 54. In such a medical ligation and suturing device 801, the ligation tool 40 can be easily replaced. Other configurations are similar to the medical ligation and suture device 701.

Further, the overtube 7 as shown in FIG. 1 may be manufactured from a colorless material, and a label may be provided on the outer peripheral surface thereof so that the positions of the biological tissue W1 to be ligated and the side opening 95 can be confirmed. For example, the marker 900 shown in FIG. 55 is provided on the outer peripheral surface of the tip tube 91 along the peripheral edge of the side opening 95. Further, among the peripheral edges, the respective portions 900a and 900b of the edge portion on the distal end side and the edge portion on the proximal end side are extended in the circumferential direction to form an annular shape. The label 900 is colored, for example, green so that it can be easily distinguished from the surrounding tissue. Further, as shown in FIG. 56, a cross-shaped marker 901 orthogonal to the length direction and the circumferential direction of the tip tube 91 is provided at a position 180 degrees out of phase with the side opening 95. The orthogonal portion 902 of the sign 901 is 180 degrees out of phase with respect to the center of the side opening 95. As shown in FIG. 53, the end portion 901a of the portion along the circumferential direction reaches the peripheral edge portion of the side opening 95. Further, as shown in FIG. 56, the tip end 903 and the base end 904 of the portion along the length direction extend beyond the annular portion 900a and the portion 900b of the label 900, respectively. Such a label 901 is colored blue, for example. As shown in FIG. 57, these labels 900,901 are used to locate the lateral opening 95 and the biological tissue W1 in the body cavity using an endoscope 6. That is, the overtube 7 is inserted from the esophagus W2 to the upper part of the stomach W3, the endoscope 6 is projected from the tip thereof, and the endoscope 6 is curved so that the markers 900 and 901 come within the field of view virtually shown in the figure. Let me. Part of sign 900 900a, By observing the position of 900b, the position of the biological tissue W1 and the side opening 95 in the advancing / retreating direction of the overtube 7 is adjusted, and by observing the position of the orthogonal portion 902 of the marker 901, the position of the side opening 95 in the rotation direction. Adjust the position. Here, as shown in FIG. 56, the marker 910 may be provided on the 90 side of the tube body as well. The sign 910 is provided at a position where the side opening 95 and the needle body 14 are aligned with the base end 904 of the sign 901 when the arrangement is suitable for ligation. That is, when the tip tube 91 is rotatable as shown in FIG. 27 or the like, if the tip tube 91 is positioned so that the label 901 and the label 910 are aligned with each other, the rotation position of the tip tube 91 is optimized. Can be set to any position.

[Appendix 1] The medical ligation and suturing device according to claim 1, wherein the operating portion is provided with the puncture handle and the pressing handle detachably attached to the housing. In this medical ligation and suture device, the puncture needle can be replaced by removing the puncture handle and the pressing handle from the housing. [Appendix 2] The medical ligation and suture device according to claim 1, wherein the operation unit is provided with the ligature tool detachably attached to the housing. In this medical ligation and suture device, the part related to ligation can be replaced by removing the ligation tool from the housing.

<figref num="1">It is the schematic which shows the structure of the medical ligation suture apparatus in embodiment of this invention.</figref><figref num="2">It is a top view of the operation part side of the medical ligation suture device.</figref><figref num="3">It is sectional drawing which shows the structure of a puncture needle.</figref><figref num="4">It is sectional drawing along the IV-IV line of FIG.</figref><figref num="5">It is a top view which shows the structure of a ligature.</figref><figref num="6">It is a partial cross-sectional view which shows the tip part of a ligature.</figref><figref num="7">It is a figure which shows the arrangement of the tip part of a ligature and a cutter part.</figref><figref num="8">It is a perspective view which shows the arrangement of a cutter part.</figref><figref num="9">It is a side sectional view which shows the structure of a housing.</figref><figref num="10">It is a top view of the housing.</figref><figref num="11">It is a cross-sectional perspective view of a tube.</figref><figref num="12">It is sectional drawing of the tip part of an overtube.</figref><figref num="13">It is a perspective view which shows the state which the tip tube and the tube body are separated.</figref><figref num="14">It is a figure explaining the operation at the time of inserting a puncture needle.</figref><figref num="15">It is a perspective view which shows the position of the initial state of a ligature.</figref><figref num="16">It is a perspective view which shows the state in which the ligature is most advanced.</figref><figref num="17">It is a figure explaining the operation of the medical ligation suture apparatus, and is the figure which shows the arrangement in the initial state.</figref><figref num="18">It is a figure explaining the operation when the pressing handle is moved forward.</figref><figref num="19">It is a figure explaining the state which the pressing handle and the ligature are interlocked.</figref><figref num="20">It is a side view explaining the state which the connection between a pressing handle and a puncturing handle is released.</figref><figref num="21">It is a figure explaining the state when the pressing handle is pushed forward most.</figref><figref num="22">It is a figure explaining the state when the pressing handle is pulled back.</figref><figref num="23">It is a figure explaining the operation at the time of ligation.</figref><figref num="24">It is a figure explaining the operation of a cutter.</figref><figref num="25">It is a figure explaining the state which cut the ligature thread with a cutter.</figref><figref num="26">It is the schematic which shows the ligated biological tissue.</figref><figref num="27">It is a side view which shows the state which the tip tube and the tube body are separated.</figref><figref num="28">It is a perspective view which shows the state which the tip tube and the tube body are separated.</figref><figref num="29">It is a perspective view which shows the state which attached the tip tube to the tube body.</figref><figref num="30">It is a figure explaining the operation of the medical ligation suture apparatus, and is the side view which shows the arrangement in an initial state.</figref><figref num="31">It is a figure explaining the state which advanced the ligature.</figref><figref num="32">It is a figure explaining the state which pushed forward the pressing handle most.</figref><figref num="33">It is a figure explaining the operation of ligating after retracting a pressing handle.</figref><figref num="34">It is a figure explaining the operation of the medical ligation suture apparatus, and is the side view which shows the arrangement in an initial state.</figref><figref num="35">It is a figure explaining the state in which the pressing handle is advanced and the connection between the pressing handle and the puncture handle is released.</figref><figref num="36">It is a figure explaining the state which pushed forward the pressing handle most.</figref><figref num="37">It is a figure explaining the operation of the medical ligation suture apparatus, and is the side view which shows the arrangement in an initial state.</figref><figref num="38">It is the top view of the base end side of the operation part.</figref><figref num="39">It is a side view which shows the state which the pressing handle and the ligature are connected.</figref><figref num="40">It is a top view which shows the state which the pressing handle and the ligature are connected.</figref><figref num="41">It is a figure explaining the state which advanced the ligature.</figref><figref num="42">It is a figure explaining the operation of the medical ligation suture apparatus, and is the side view which shows the arrangement in an initial state.</figref><figref num="43">It is a figure explaining the operation of the medical ligation suture device, and is the side view which advanced only the needle body.</figref><figref num="44">It is a figure which shows the state which pushed forward the pusher.</figref><figref num="45">It is a figure explaining the operation of the medical ligation suture apparatus, and is the side view which shows the arrangement in an initial state.</figref><figref num="46">It is a figure explaining the state in which the pressing handle, the puncture handle, and the ligature are interlocked.</figref><figref num="47">It is a figure explaining the state which pushed forward the pressing handle most.</figref><figref num="48">It is a figure explaining the state which advanced only the ligature.</figref><figref num="49">It is a figure explaining the state which advanced only the needle body.</figref><figref num="50">It is a figure explaining the state which advanced only a pusher.</figref><figref num="51">In the figure explaining the layout of cutting the ligature thread with the forceps of the endoscope.</figref><figref num="52">It is a figure which shows the state which cut the ligature thread with the forceps of an endoscope.</figref><figref num="53">It is a side view which shows the structure of the operation part.</figref><figref num="54">It is a side view which shows the structure of the operation part.</figref><figref num="55">It is a perspective view of the tip part of an overtube.</figref><figref num="56">It is a perspective view of the tip part of the overtube, and is the figure rotated 180 degrees from the state of FIG.</figref><figref num="57">It is a figure explaining the operation of the positioning of the medical ligation suture device.</figref>

Code description

1,201,301,401,501,601,701,801 Medical ligature and suture device 2,202,302,402,502,602 Operation unit 3 Housing 7 Overtube (tip insertion part) 10,210,310,410 Penetration needle 13 Pusher (pressing member) 14 Needle body 17 Holding member 18 Ligature thread (ligature member) 20,220,420 , 1st interlocking device) 24 Elastic member (interlocking device, 1st interlocking device) 30,230,330,430,530 Pressing handle 35 Interlocking member (interlocking device, 2nd interlocking device) 40 Ligature 41,441 Operation unit 42 Ligature sheath 45 Hook 47 Stopper 55 Ligature handle 95 Side opening 223 pin 460,560 interlocking device W1 living tissue