JP7188688B2 - Endoscope hood assembly, and endoscope hood and traction member used in endoscope hood assembly - Google Patents

Description

The present invention relates to an endoscope hood assembly, and an endoscope hood and a traction member used in the endoscope hood assembly.

In recent years, when a local procedure is performed in the body, an endoscope insertion section (hereinafter referred to as "endoscope insertion section") is orally inserted into the body without resorting to surgical laparotomy. Endoscopic surgery is widely performed. In particular, in the gastrointestinal tract such as the esophagus, stomach, and large intestine, for early cancers that remain localized without metastasis, treatment tools that are guided to the lesion through the treatment tool insertion passage of the endoscope are used to treat mucous membranes. Surgical excision of localized lesions has been employed.

Such endoscopic resection is roughly classified into three techniques. That is, (a) endoscopic polypectomy (polypectomy), (b) endoscopic mucosal resection (EMR) and (c) endoscopic submucosal dissection (ESD) Dissection).
Of these, (c) endoscopic submucosal dissection (hereinafter simply referred to as "ESD") is performed through the following steps, for example, in order to completely excise the lesion together with the surrounding non-lesioned area. be done.
(1) Insert the endoscope insertion section into the gastrointestinal tract from outside the body and reach the target site for resection.
(2) Determine the excision range including the lesion by marking or the like.
(3) Inject physiological saline or the like into the submucosal layer to float the resection area.
(4) The mucosal layer is incised using a treatment tool (knife or the like) guided to the vicinity of the resection range through the treatment tool insertion passage of the endoscope to expose the submucosal layer (mucosal layer incision).
(5) detachment of the submucosal layer from the underlying muscularis propria (submucosal detachment);
By repeating these steps, the resection area can be resected to completely resect the lesion.

However, in the step (5) of submucosal layer ablation, part of the submucosal layer being excised covers the distal end surface of the insertion portion of the endoscope, etc. (covering). Therefore, it becomes difficult or impossible to macroscopically see the site to be excised next. In other words, it is not possible to view the whole part to be resected next, including other parts, while the camera lens of the endoscope is retracted from the part to be resected.
When performing submucosal detachment, it is necessary to pay close attention not to damage the underlying muscularis propria, but the operation must be performed while overcoming such a difficult situation of "covering". Therefore, a practitioner is required to have extensive experience and advanced skills in ESD.
In addition, when a lesion is excised by surgical laparotomy without using an endoscope, one end of the lesion can be grasped and rolled up with the left hand. However, in the case of ESD, there is generally only one endoscope insertion section that is inserted into the body, so there is nothing equivalent to the left hand of a person who performs laparotomy. For this reason, in the case of ESD, there is also the circumstance that it is not possible to turn up one end of the lesioned part, which corresponds to the left hand.

On the other hand, a clip pulling method has been conventionally proposed.
FIG. 10 is a diagram shown for explaining a conventionally used clip pulling method.
In the clip traction method, a clip 710 attached to the tip of a wire 730 inserted through a treatment instrument insertion passage 628 of an endoscope insertion portion 620 is used to pull a body tissue at a site to be retracted (lesions, gastrointestinal mucosa (upper mucosa)). , submucosa, etc.), etc., and is towed. In the above example, this is the part of the submucosa that is being removed. >> and pulling the thread 740 connected to the claw 711 of the clip 710 from the outside of the body to pull the towed part and turn up a part of the lesion (Fig. 10 and Non-Patent Document 1 to 3).

However, in order to carry out the clip traction method, the endoscope insertion portion 620 must be once removed from the body after incising the mucosa layer with a knife. That is, in order to perform the clip traction method, (1) the endoscope insertion portion 620 is withdrawn from the body and temporarily pulled out of the body; A clip 710 exposed outside (the clip 710 may be inserted through the instrument insertion passage 628 together with the wire 730, or may be separately attached to the tip of the wire 730 protruding from the forceps opening 623). ), (3) let the thread 740 run along the outside of the endoscope insertion portion 620 (outside of the sheath), and (4) again endoscope insertion portion 620 must go through a series of preparatory steps to insert it into the body.

Going through such preparatory steps imposes a heavy burden on both the patient and the operator. Moreover, since such preparation steps require a certain amount of time or more, smooth towing cannot be performed. For this reason, it is difficult to adopt the clip traction method in an emergency, such as when a lesion is towed and the bleeding site is unfolded and the situation is viewed directly with an endoscopic camera.

As an improvement of the clip traction method, a method of performing ESD using a special traction member in which a spring and a loop are attached to a special clip has also been proposed (see FIG. 11. See also Non-Patent Document 4). ).

FIG. 11 is a diagram for explaining a conventionally used special traction member 900. As shown in FIG. FIG. 11(a) is a diagram illustrating the configuration of the special traction member 900. FIG. FIG. 11(b) is a diagram showing how the special traction member 900 is introduced into the body. FIG. 11(c) is a diagram showing how the towed part 810 is towed using the special towing member 900. As shown in FIG. Reference numeral 822 denotes mucous membrane, reference numeral 824 denotes submucosa, and reference numeral 826 denotes muscularis propria. These are collectively shown as a gastrointestinal tract wall 820, and further shown as a body tissue 800 as a higher concept.
As shown in FIG. 11( a ), the special pulling member 900 has one end of a coil spring 912 attached to one claw of a clip 914 and a nylon loop 910 attached to the other end of the coil spring 912 . As shown in FIG. 11(b), the special traction member 900 has a clip 914 (on the side of the spring portion 915) attached to the distal end of the wire 730, and extends along with the wire 730 into the treatment instrument insertion passage (not shown) of the endoscope insertion section 620. omitted), and introduced into the body so as to emerge from the forceps opening 623 of the distal end portion 621 of the endoscope.
According to the special pulling member 900, as shown in FIG. 11(c), one end of the towed portion 810 is clipped with a clip 914 (clipping is performed by tightening the nail with a tightening ring 712 to fix the clip), By moving the clip 710 in the direction indicated by the arrow while hooking the nylon loop 910 with the claw of another clip 710, the part 810 to be pulled is pulled and a part of the part corresponding to the lesion 812 is rolled up. be able to. Also, by clipping another clip 710 to the wall of the gastrointestinal tract on the side opposite to the towed portion 810, the special pulling member 900 can be stretched in the gastrointestinal tract and kept rolled up.

Yoshiki Koike, et al., ``Usefulness of clip traction with thread in esophageal ESD: a randomized controlled trial,'' Journal of the Japan Gastroenterological Endoscopy Society, Vol.57 (1), Jan.2015, p.66 -73 Masaya Uesato, et al., ``Efficacy of clip traction method in esophageal endoscopic submucosal dissection,'' Chiba Medical Journal, Chiba Medical Society, June 2011, Vol. 87, p.237-243 Tsuneo Koyama, 6 others, ``Expansion of application of gastric EMR: Ingenuity and results of procedure aimed at en bloc resection considering size,'' Stomach and Intestines, Igakushoin, August 2002, Vol.37, No.9, p.1155-1161 Naoto Sakamoto, Taro Nagata, "Traction method in ESD", [online], Zeon Medical Co., Ltd. website, [searched June 7, 2018], Internet (URL: http://www.zeonmedical.co.jp/ case_report/portal/circulation/pdf/0003.pdf)

However, the special traction member 900 can be applied as the special traction member 900 because it is premised that it can pass through the treatment instrument insertion passage (not shown) of the endoscope 600 and the forceps opening 623. There are restrictions on size (diameter, length, etc.) and shape. In other words, the clip 914/coil spring 912 having an outer diameter larger than the inner diameter of the treatment instrument insertion passage cannot be applied.
Further, if the special traction member 900 is to be stretched over a relatively long distance (traction reach) in the gastrointestinal tract, it is necessary to insert the special traction member having a long coil spring into the treatment instrument insertion passage. It takes time to put in and take out the special pulling member 900 for adjustment, and the pulling cannot be performed smoothly.
Furthermore, since the diameter of the nylon loop 910 of the special pulling member 900 is relatively small, it may be necessary to repeat the action of hooking the claw of the clip on this loop many times. can't do

Therefore, the present invention has been made in view of the above-described circumstances, and is capable of assisting smoother traction than before when an endoscope is used to retract a body tissue to be retracted. An object of the present invention is to provide an endoscope hood assembly, and an endoscope hood and a traction member used in the endoscope hood assembly.

[1] An endoscope hood assembly according to the present invention is an endoscope hood assembly that is attached to the distal end of an insertion section of an endoscope, and has a plurality of loops that can be hooked onto the claws of a clip. It has an elongated shape as a whole, and one end thereof is clipped to a body tissue to be pulled by the clip hooked on the loop portion so that the towed portion can be pulled from the other end. a traction member configured, a first opening serving as a side to which the distal end portion of the endoscope insertion section is fitted, and a side of the first opening that is connected to the distal end portion of the endoscope insertion section. a substantially cylindrical endoscopic hood having a second opening on which a treatment instrument protruding from the forceps port of the distal end portion when fitted, enters and exits; is provided with a traction member accommodating portion in which the traction member is accommodated, and a third opening connected to the traction member accommodation portion, and at least part of the traction member is the traction member. The traction member is accommodated in the member accommodation portion, and the traction member is a drawer hook portion of the traction member when the endoscope hood assembly is attached to the distal end portion of the endoscope insertion portion. is locked in the locking portion of the endoscopic hood so as to be positioned forward of the distal end face of the endoscope insertion portion, and the claws of the forceps or the clip are engaged with the pulling member. A part of the traction member accommodated in the traction member accommodation portion is configured to be pulled out from the third opening when the drawer hook is hooked to move forward. do.

In the endoscopic hood assembly of the present invention (hereinafter sometimes simply referred to as the "hood assembly"), the endoscopic hood includes a traction member accommodating portion for accommodating a traction member and a traction member accommodating portion for accommodating the traction member. A third opening connected to the member receiving portion is provided, and at least a portion of the traction member is received in the traction member receiving portion. Further, the traction member is positioned so that the drawer hook portion of the traction member is located forward of the distal end face of the endoscope insertion portion when the endoscope hood assembly is attached to the distal end portion of the insertion portion of the endoscope. is locked at the locking portion of the endoscope hood. Therefore, when the forceps or clip is protruded from the forceps port and advanced with the claws open, the claws can hook the pull-out hooks of the traction member. When the forceps or the clip is further advanced while hooking the drawer hook, part of the traction member accommodated in the traction member accommodation portion is pulled out from the third opening.
For this reason, if the hood assembly is attached to the distal end portion of the insertion section of the endoscope, the insertion section of the endoscope can be maintained even after the insertion of the insertion section into the body and incision of the mucosal layer. The pulling member can be pulled out from the endoscope hood simply by hooking the pull-out hook with forceps or the claw of the clip and moving forward while maintaining the state where the pulling member is inserted into the body.
Therefore, it is possible to remove and reinsert the endoscope insertion section just to insert the traction member (thread) into the body as in the past, or to reinsert the special traction member into the treatment instrument insertion passage. Therefore, the pulling member can be easily introduced into the body, and the pulling operation can be started immediately.
Therefore, according to the hood assembly of the present invention, it is possible to support smoother traction when using an endoscope to retract a body tissue to be retracted, as compared with the conventional hood assembly.

[2] In the endoscope hood assembly of the present invention, the traction member accommodating portion is formed by a storage chamber formed between an outer peripheral wall and an inner peripheral wall of the substantially cylindrical endoscope hood. Preferably, the third opening is connected to the storage chamber and opens to face the front side of the endoscope hood.

[3] In the endoscopic hood assembly of the present invention, it is preferable that the endoscopic hood is provided with the traction member accommodating portions at a plurality of locations.

[4] In the endoscope hood assembly described in [3] above, it is preferable that separate traction members are housed in the plurality of traction member housing portions.

[5] In the endoscope hood assembly described in [3] above, the traction member is provided with at least one loop portion on each of the one end side and the other end side, and The loop portion and the loop portion on the other end side are connected by a connecting portion, and the loop portion on the one end side and the loop portion on the other end side are provided at different locations. and the connecting portion of the pulling member partially straddles the inside of the second opening, and the connecting portion is configured as the drawer hanging portion. preferably.

[6] An endoscope hood according to the present invention is an endoscope hood attached to a distal end portion of an endoscope insertion section, the endoscope hood being substantially cylindrical and having the above-described a first opening on which the distal end portion of the endoscope insertion portion is fitted; and the distal end portion when the first opening side is fitted to the distal end portion of the endoscope insertion portion. The endoscope hood has a second opening on which a treatment instrument protruding from the forceps port of the endoscopic hood enters and exits. and a third opening that is connected to the traction member storage section and serves as an outlet for the traction member, and the endoscope hood is connected to the endoscope insertion section. A part of the traction member may be locked so that the hook for drawing out of the traction member is positioned forward of the distal end surface of the endoscope insertion portion when attached to the distal end. The present invention is characterized in that a locking portion is provided that can be used.

The endoscopic hood of the present invention is provided with a traction member accommodating portion for accommodating a traction member used for pulling tissue in the body, and a hook portion for drawing out the traction member is attached to the insertion portion of the endoscope. A locking portion that can lock a part of the traction member is provided so as to be positioned forward of the tip surface.
Therefore, if the traction member is housed in the traction member storage portion in advance, the traction member can be moved forward through the third opening by hooking the pull-out hook portion with forceps or the claws of a clip. can be pulled out.
Therefore, it is possible to remove and reinsert the endoscope insertion section just to insert the traction member (thread) into the body as in the past, or to reinsert the special traction member into the treatment instrument insertion passage. Therefore, the pulling member can be easily introduced into the body, and the pulling operation can be started immediately.
Therefore, according to the endoscopic hood of the present invention, it is possible to assist smoother traction when using an endoscope to retract a body tissue to be retracted, compared with the conventional hood.

[7] In the endoscope hood of the present invention, the traction member accommodating portion is constituted by a storage chamber formed between an outer peripheral wall and an inner peripheral wall of the substantially cylindrical endoscope hood. Preferably, the third opening is connected to the storage chamber and opens to face the front side of the endoscope hood.

[8] In the endoscope hood of the present invention, it is preferable that the storage chamber is a cavity formed to extend along a direction parallel to the central axis of the substantially cylindrical shape of the endoscope hood.

[9] In the endoscope hood of the present invention, it is preferable that a plurality of the traction member accommodating portions are provided.

[10] A traction member of the present invention is a traction member used for pulling a body tissue to be pulled in a procedure using an endoscope, wherein the traction member is biocompatible. It is formed by weaving high fibers into an elongated shape as a whole, has a plurality of loops that can be hooked on the claws of a clip, and one end is clipped to the towed part by the clip hooked on the loops. A pulling member accommodating portion provided in an endoscope hood attached to the distal end portion of the endoscope insertion portion of the endoscope and configured to allow the pulled portion to be pulled from the other end side of the endoscope. It is characterized by being accommodated in.

Since the traction member of the present invention is formed by weaving fibers, when traction is performed using this, the traction member expands and contracts appropriately, so that the region to be pulled can be gently pulled.
In addition, since the traction member of the present invention has an uneven surface formed by woven fibers, it is less likely to adhere to the inner wall of the gastrointestinal tract, etc., as compared to the case where a non-woven material is used. Therefore, it becomes a traction member that can be easily picked up by the treatment instrument.
Therefore, according to the traction member of the present invention, it is possible to support smoother traction than in the past when the body tissue is to be tractioned using an endoscope.

[11] In the traction member of the present invention, the traction member is configured such that a plurality of the loop portions are continuously connected on at least one end side of the one end side or the other end side. is preferred.

[12] In the traction member of the present invention, it is preferable that virtual planes formed by the plurality of loop portions are not on the same plane when the traction member is placed on a horizontal plane.

6 is a diagram showing how the endoscope hood assembly 1 according to Embodiment 1 is attached to the endoscope insertion portion 620. FIG. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a view for explaining an endoscope hood assembly 1 according to Embodiment 1, and an endoscope hood 200 and a traction member 100 used therein; 4A and 4B are diagrams for explaining a method of assembling the endoscope hood assembly 1 according to the first embodiment; FIG. FIG. 4 is a view for explaining a usage example of the endoscope hood assembly 1 according to Embodiment 1; FIG. FIG. 4 is a view for explaining a usage example of the endoscope hood assembly 1 according to Embodiment 1; FIG. FIG. 11 is a view for explaining an endoscope hood assembly 2 according to Embodiment 2; FIG. 11 is a diagram for explaining endoscope hoods 200b and 200c according to a modification; FIG. 10 is a diagram for explaining traction members 100′, 100b, 100c, 100d, 100″, and 100e according to modifications. FIG. 11 is a view for explaining an endoscope hood assembly 3 using a traction member 100e according to a modification; It is a figure shown in order to demonstrate the clip pulling method used conventionally. FIG. 10 is a diagram shown for explaining a conventionally used special traction member 900;

BEST MODE FOR CARRYING OUT THE INVENTION An endoscope hood assembly of the present invention, and an endoscope hood and a traction member used in the endoscope hood assembly will be described below based on embodiments shown in the drawings. Each drawing is a schematic diagram and does not necessarily strictly reflect actual dimensions.

[Embodiment 1]
1. Configurations of Endoscope Hood Assembly 1, Endoscope Hood 200, and Traction Member 100 (1) Relationship Between Endoscope Hood Assembly 1 and Endoscope Insertion Portion 620 FIG. endoscope hood assembly 1 (hereinafter sometimes simply referred to as "hood assembly 1"; hereinafter, the same applies to endoscope hood assemblies 2 and 3) is inserted into endoscope insertion section 620. It is a figure which shows a mode when mounting|wearing. FIG. 1(a) shows the mounting relationship between the endoscope hood assembly 1 and the endoscope insertion section 620, and FIG. 1 shows a view when viewed from a direction perpendicular to .

As shown in FIG. 1( a ), the endoscope hood assembly 1 according to Embodiment 1 is attached to a distal end portion 621 of an endoscope insertion section 620 . Also, the hood assembly 1 can be removed from the distal end portion 621 after being attached to the distal end portion 621 of the endoscope insertion portion 620 . The hood assembly 1 can also be said to be an attachment for the endoscope insertion section 620 .
The hood assembly 1 has a substantially cylindrical shape, and is fitted to the distal end portion 621 of the endoscope insertion portion 620 on the side of the first opening (details will be described later).

As the endoscope 600 to which the endoscope hood assembly 1 is attached, a general endoscope can be used.
As shown in FIG. 1A, the endoscope 600 is roughly divided into an endoscope insertion section 620, an operation section 610, an external device 630, and the like. The endoscope insertion portion 620 is a portion to be inserted into the body, and has a treatment instrument insertion passage (not shown in FIG. 1) and the like inside and is covered with a sheath. An operation unit 610 is a portion where the operator performs operations related to endoscopic surgery, and has buttons 611, an angle knob 612, a treatment instrument insertion port 613, and the like. The external device 630 has a light source device, an image processing device, a monitor, etc., which are not shown.
A distal end portion 621 of the endoscope insertion portion 620 has a substantially cylindrical shape and can be fitted with the hood assembly 1 . A distal end surface 622 of the endoscope insertion portion 620 includes, for example, a forceps port 623 that is the exit of a treatment instrument insertion passage (not shown), a light emitting portion 624 that illuminates the inside of the body, and a port that receives optical information. A camera lens 625 and a nozzle 626 for introducing liquid or gas into the body are provided (see FIG. 1B). >>. Examples of treatment instruments that can be passed through the treatment instrument insertion passage and the forceps opening 623 include knives, forceps, clips, and the like.

(2) Endoscope Hood Assembly 1, Endoscope Hood 200 and Traction Member 100
FIG. 2 is a view for explaining the endoscope hood assembly 1 according to Embodiment 1, and the endoscope hood 200 and traction member 100 used therein. FIG. 2(a) is a perspective view of the endoscope hood assembly 1 as viewed obliquely from above on the side of the second opening 202. FIG. The side of the second opening 202 is defined as the front, and the side of the first opening 201 is defined as the back. FIG. 2B is a front view of the endoscope hood assembly 1 viewed from the second opening 202 side. FIG. 2(c) is a right perspective view of the traction member 100 seen from the right side of the endoscope hood assembly 1. FIG. FIG. 2(d) is a cross-sectional view of the endoscope hood assembly 1 cut along line AA in FIG. 2(c) and viewed along line AA. FIG. 2D also synthetically shows how the hood assembly 1 is attached to the distal end portion 621 of the endoscope insertion portion 620 and the forceps 720 or the clip 710 protrudes from the forceps port 623 .

As shown in FIG. 2, the endoscope hood assembly 1 includes an endoscope hood 200 and a traction member 100 housed in a traction member housing portion 220 of the endoscope hood 200. .

(2-1) traction member 100
The traction member 100 has a plurality of loop portions 120 that can be hung on the claws 711 of the clip 710 . The pulling member 100 has an elongated shape as a whole, and one end thereof is clipped to the body tissue to be pulled by a clip 710 hooked on the loop portion 120, and the pulling member 100 is pulled from the other end. is configured so that
For example, as shown in FIG. 2, the traction member 100 is provided with at least one loop portion 120 on each of one end side and the other end side, and the loop portion 120 on the one end side and the loop portion 120 on the other end side are connected. It may be formed as a “connected type” so as to be connected by the connecting portion 130 (see FIG. 2, and also refer to the description below and FIG. 3, etc.). >>.
The detailed configuration and usage of the traction member 100 will be described later.

(2-2) Endoscope hood 200
(a) First opening 201 and second opening 202
The endoscope hood 200 has a substantially cylindrical shape with a first opening 201 and a second opening 202 .
The first opening 201 is an opening into which the distal end portion 621 of the endoscope insertion portion 620 is fitted. The second opening 202 is an opening on which a treatment instrument that protrudes from a forceps port 623 of the distal end portion 621 when the first opening 201 side is fitted to the distal end portion 621 of the endoscope insertion portion 620 enters and exits. Department. The inner diameter of the endoscope hood 200 is designed to have dimensions, shape, etc., corresponding to the outer diameter dimensions, shape, etc. of the distal end portion 621 of the endoscope insertion portion 620 to be mounted.
In addition, in FIG. 2 and the like, the central axis of the cylinder is indicated by symbol AX1. In this specification, the side of the second opening 202 is referred to as the front, and the side of the first opening 201 is referred to as the rear. Further, the direction from the side of the first opening 201 to the side of the second opening 202 is called "forward", and the movement forward is called "advance".

(b) Traction member housing portion 220
The endoscope hood 200 is provided with a traction member accommodating portion 220 in which the traction member 100 is accommodated. The traction member accommodating portion 220 may be configured in any manner as long as it can accommodate the traction member 100 . As shown in FIG. 2D and the like, the traction member accommodating portion 220 is constituted by a storage chamber 222 formed between the outer peripheral wall 205 and the inner peripheral wall 206 of the substantially cylindrical endoscope hood 200. preferably. More preferably, the storage chamber 222 is formed of a cavity HL extending along a direction parallel to the central axis AX1 of the substantially cylindrical shape of the endoscope hood 200 .

In the endoscope hood 200, it is preferable that the traction member accommodating portions 220 are provided at a plurality of locations. FIG. 2 and the like show a configuration in which two traction member accommodating portions 220 are provided.
Moreover, it is preferable that locking portions 230 , which will be described later, are provided so as to correspond to the respective traction member accommodating portions 220 . By doing so, the individual traction members 100 housed in the respective traction member housing portions 220 can be locked to the endoscope hood 200 .

(c) Third opening 203
The endoscope hood 200 is provided with a third opening 203 connected to the traction member accommodating portion 220 . The third opening 203 may be configured in any manner as long as it interferes with the withdrawal of the traction member 100 from the traction member accommodating portion 220 . The third opening 203 is connected to the storage chamber 222 and preferably opens facing the front side of the endoscope hood 200 .

(d) locking portion 230
The endoscope hood 200 is provided with a locking portion 230 that locks the traction member 100 . The locking portion 230 locks the traction member 100 so that the traction member 100 is detachably temporarily fixed to the endoscope hood 200 . The engaging portion 230 may be configured in any manner as long as the pulling member 100 can be engaged and can be temporarily fixed to the endoscope hood 200 . For example, even if the rim of the second opening 202 of the endoscope hood 200 is formed in a concave shape such as a U-shape, a V-shape, an arc shape, or a keyhole shape so that the traction member 100 can be held therebetween. Good (see FIG. 2(c), etc.). >>. Further, the engaging portion 230 also includes a portion configured to temporarily fix the traction member 100 to a portion of the endoscope hood 200 with an adhesive having a certain degree of adhesion.

(2-3) Relationship Between Traction Member 100 and Endoscope Hood 200 At least part of the traction member 100 is housed in the traction member housing section 220 .
In the hood assembly 1 illustrated in FIG. 2, a plurality of traction member housing portions 220 are provided, and the traction members 100 housed therein are "connected type" traction members. Therefore, here, the loop portion 120 on the one end side and the loop portion 120 on the other end side of the traction member 100 are accommodated in the traction member accommodation portions 220 provided at different locations. That is, the loop portion 120 on the one end side and the loop portion 120 on the other end side are accommodated in the traction member accommodation portion 220 on the right side and the traction member accommodation portion 220 on the left side when viewed from the front in FIG. At this time, the loop portion 120 on the one end side of the traction member 100 extends parallel to the central axis AX1 inside a storage chamber 222 (more specifically, a cavity HL) formed between the outer peripheral wall 205 and the inner peripheral wall 206. (see FIG. 2(c)). >>. The loop portion 120 on the other end side is similarly accommodated.

FIG. 2(d) also compositely shows a state when the endoscope hood assembly 1 is attached to the distal end portion 621 of the endoscope insertion portion 620. As shown in FIG.
As shown in FIGS. 2( c ) and 2 ( d ), the traction member 100 is a traction member when the endoscope hood assembly 1 is attached to the distal end portion 621 of the endoscope insertion section 620 . 100 is locked by the locking portion 230 of the endoscope hood 200 so that the hook portion 140 for drawer 100 is positioned forward of the distal end surface 622 of the endoscope insertion portion 620 .
Here, the "drawer hook 140" is a portion that constitutes a part of the traction member 100, and is hooked with forceps or a claw of a clip when the traction member 100 is pulled out from the traction member housing portion 220. It is the part where For example, in the "connected type" traction member 100 as shown in FIG. 130 is configured as a drawer hook 140,

As described above, the hood assembly 1 is provided with the traction member accommodating portion 220, the third opening portion 203, the locking portion 230, the drawer hook portion 140, etc. A portion of the traction member 100 housed in the traction member housing portion 220 (stored portion) is pulled out from the third opening 203 when the hook 140 is hooked and the traction member 100 moves forward. there is
In the above description, "forceps or a clip" is used as the treatment tool for hooking the drawer hook 140, but the present invention is not limited to this. Other treatment instruments may be used as long as the traction member 100 can be pulled out by hooking the drawer hook 140 . For example, a hook-shaped treatment instrument or the like may be used. The scope of the present invention is equivalent to the use of such a treatment tool or the like.

2. Assembly Method of Endoscope Hood Assembly 1 FIG. 3 is a view for explaining an assembly method of the endoscope hood assembly 1 according to the first embodiment. FIG. 3(a1) is a perspective view when the traction member 100 is extended in the longitudinal direction, and FIG. It is a diagram when viewed along a horizontal plane from a direction perpendicular to the longitudinal direction of the . FIG. 3(a3) is a perspective view of the endoscope hood 200. FIG. FIG. 3B is a perspective view showing a state before the traction member 100 is accommodated in the endoscope hood 200. FIG. FIG. 3(c) is a see-through perspective view of a state in which the traction member 100 is housed in the endoscope hood 200 and the assembly of the endoscope hood assembly 1 is completed.

The endoscope hood assembly 1 can be assembled, for example, by performing the following steps.

(1) Preparation of traction member 100 First, the traction member 100 is prepared.
The traction member 100 is formed by weaving fibers with high biocompatibility into a long shape as a whole.
One end 101 of the pulling member 100 is clipped to the pulled portion by a clip hooked on the loop portion 120, and the pulled portion can be pulled from the other end 109 side, so that the pulling member 100 is hung on the claw of the clip. (see FIG. 3(a1)). >>.

The pulling member 100 is preferably configured such that a plurality of loop portions 120 are continuously linked (in other words, chain-like) on at least one of the one end 101 side and the other end 109 side. In the example of FIG. 3, a plurality of loop portions 120a, 120b, 120c, 120d, and 120e are continuously connected (five loops) on the one end 101 side, and a plurality of loop portions 120v, 120w, 120x, 120x, 120v, 120w, 120x, 120y and 120z are arranged continuously (5 series). By configuring a plurality of loops so as to be continuously connected in this way, it is possible to select an appropriate loop from among the plurality of loops and adjust the traction reach (details will be described later).
Loop portions 120 a , 120 b , 120 c , 120 d and 120 e on the one end 101 side and loop portions 120 v , 120 w , 120 x , 120 y and 120 z on the other end 109 side are connected by connecting portions 130 .

Further, as shown in FIG. 3(a2), the traction member 100 is arranged so that virtual planes formed by the plurality of loop portions are not on the same plane when the traction member is placed on a horizontal plane. preferably configured. For example, the inclination and direction of the surface formed by one loop portion of interest and the inclination and direction of the surface formed by another loop portion adjacent to the one loop portion of interest are the nodes where the loop portions are connected. It is configured to be different with the part of

An example of a traction member 100 will now be described.
A material having high biocompatibility, such as nylon fiber, is adopted as the material of the traction member 100 and woven. Further, the inner diameter of the loop portion 120 is about 5 mm to 10 mm, assuming that the length of the claw of the clip is about 10 mm and the distance between the tips of the claws when the claw is opened is about 10 mm. Adjacent loop portions 120 are bound together at the joints by tying them together. The total length of the five loops on the one end 101 side was about 30 mm to 50 mm. Five consecutive loop portions were similarly formed on the other end 109 side.

(2) Preparation of Endoscope Hood 200 In parallel with (1), prepare the endoscope hood 200 (see FIG. 3(a3)). >>.
For the detailed description of the configuration of the endoscope hood 200, the description given so far is used as it is.

The endoscope hood 200 prepared here may be of any type as long as it is used for the endoscope hood assembly 1 described above.

In other words, “the endoscope hood 200 attached to the distal end portion 621 of the endoscope insertion portion 620 , the endoscope hood 200 having a substantially cylindrical shape and the distal end portion of the endoscope insertion portion 620 . From the forceps opening 623 of the distal end portion 621 when the first opening portion 201 to which the portion 621 is fitted and the first opening portion 201 side is fitted to the distal end portion 621 of the endoscope insertion portion 620 . The endoscopic hood 200 has a second opening 202 on which the protruding treatment instrument enters and exits, and the endoscopic hood 200 accommodates a pulling member 100 used for pulling body tissue. A housing portion 220 and a third opening portion 203 connected to the traction member housing portion 220 and serving as a drawer port for the traction member 100 are provided. Part of the traction member 100 is locked so that the drawer hook 140 of the traction member 100 is positioned forward of the distal end surface 622 of the endoscope insertion portion 620 when attached to the distal end portion 621 . Any mode may be used as long as it is provided with a locking portion 230 capable of

(3) Accommodating the traction member 100 in the traction member storage portion 220 Next, the traction member 100 is folded at the connection portion 130 . FIG. 3(b) shows how it is folded into a U shape.
Then, the one end 101 side of the traction member 100 is inserted into the traction member storage section 220 through the third opening 203 on the left side of the endoscope hood 200 when viewed from the front. Similarly, the other end 109 side is inserted and housed inside the traction member housing portion 220 through the third opening 203 on the right side when viewed from the front (see FIG. 3B). >>.

(4) Locking of the pulling member 100 Next, the connecting portion 130 is temporarily fixed at the locking portion 230 on the left side of the endoscope hood 200 as viewed from the front to lock the pulling member 100 . Similarly, the connecting portion 130 is also locked at the locking portion 230 on the right side when viewed from the front (see FIG. 3(c)). >>.

(5) The endoscope hood assembly 1 can be obtained by performing the above steps.
The method of assembling the endoscope hood assembly 1 is not limited to the above.

3. Usage Examples of Endoscope Hood Assembly 1 Next, usage examples of the endoscope hood assembly 1 will be described.
FIG. 4 is a view for explaining an example of use of the endoscope hood assembly 1 according to the first embodiment. FIG. 5 is a diagram subsequent to FIG. 4 for explaining a usage example of the endoscope hood assembly 1 according to the first embodiment. 4(a) to 4(d) and 5(a) to 5(e) are diagrams showing respective steps.

(1) Attachment of the endoscope hood assembly 1 The first opening 201 side is fitted to the distal end portion 621 of the endoscope insertion portion 620, and the endoscope hood assembly 1 is viewed through the end. It is attached to the distal end portion 621 of the speculum insertion portion 620 (See FIG. 4(a). >>.

(2) Inserting the endoscope insertion section 620 into the body Next, with the endoscope hood assembly 1 attached, the endoscope insertion section 620 is inserted into the body from the outside of the body until it reaches the vicinity of the resection target site. (Illustration omitted.).

(3) Mucous membrane layer incision Next, the knife 750 is guided through the treatment instrument insertion path (not shown) to the vicinity of the resection range, and the knife 750 is used to incise the mucosal layer 822 to expose the submucosal layer 824. See 4(b). >>.
Prior to incision of the mucosal layer, the resection range including the lesion 812 is determined, marked as necessary, and physiological saline or the like is injected into the submucosal layer 824 to float the resection range.

(4) Insertion of first clip 715 Next, the first clip 715 is inserted through the treatment instrument insertion port 613 of the operation section 610 of the endoscope (see FIG. 4(c)). >>.

(5) Pulling out the traction member 100 Next, the first clip 715 is advanced in order within the treatment instrument insertion passage 628 to protrude from the forceps opening 623 of the distal end surface 622 of the endoscope insertion portion 620 . The first clip 715 is further advanced with the claw 711 opened, and the claw 711 hooks the drawer hook 140 of the traction member 100 (see FIG. 4(d)). >>. The first clip 715 is further advanced while hooking the drawer hook 140, and the traction member 100 housed in the traction member housing portion 220 is pulled out from the third opening 203 (see also FIG. 2).
In this manner, the retraction member 100 can be advanced and withdrawn to the vicinity of the retracted site 810 (see FIG. 5) within the body. Note that forceps (not shown) may be used instead of the first clip 715 to pull out the traction member 100 into the body.

(6) Clipping while hooking the loop portion on the one end 101 side of the traction member 100 Next, hook the loop portion 120 on the one end 101 side of the traction member 100 with the claw 711 of the first clip 715, and pull the claw 711. Pass it through the ring of the loop portion (loop portion 120a in the figure). Then, the first clip 715 grips a portion of the towed portion 810 (see FIG. 5(a)). >>.

(7) Fixing the first clip 715 and mooring the one end 101 side of the pulling member 100 Next, the claw 711 is closed by the tightening ring 712 of the first clip 715, and the first clip 715 is attached to a part of the pulled part 810. fixed. At the same time, the one end 101 side of the traction member 100 hooked on the claw 711 of the first clip 715 is also anchored to the first clip 715 (see FIG. 5B). >>.

(8) Insertion of the second clip 716 Next, the second clip 716 is inserted through the treatment instrument insertion opening 613 of the operation section 610 of the endoscope (see FIG. 5(c)). >>.

(9) Hooking the loop portion on the side of the other end 109 of the traction member 100 Next, hook the loop portion 120 on the side of the other end 109 of the traction member 100 with the claw 711 of the second clip 716, and loop the claw 711. It is passed through the ring of the part 120 (See FIG. 5(d). >>.
At this time, when the traction member 100 is formed so that a plurality of loop portions 120 are continuously connected on the other end 109 side, the tension length (traction reach) of the traction member is assumed. <In the example of FIG. 5D, the third loop portion 120x from the other end 109 is selected. 》

(10) Pulling Part 810 to be Pulled and Fixing Other End 109 of Pulling Member 100 Next, the second clip 716 pulls the other end 109 of the pulling member 100 .
For example, if the pulled part 810 including the lesion 812 is distributed on one side of the gastrointestinal tract wall 820a, the gastrointestinal tract is pulled in the direction (the other side) of the gastrointestinal tract wall 820b located in the desired direction to be pulled. Then, the second clip 716 may be fixed by clipping to the digestive tract wall 820b on the other side.
In this way, a portion of the to-be-pulled site 810 including the lesion 812 can be pulled and rolled up. This makes it possible to ensure a good view of the region OS (in this example, the forefront region where peeling occurs) where treatment such as peeling is to be performed (see FIG. 5(e)). >>.
Since a good field of view can be provided, it can also contribute to prevention of troubles such as excessive peeling and blood vessel damage.

(11) Each operation of steps (1) to (10) can be performed by a practitioner. By performing these steps, the retracted portion 810 of body tissue 800 can be retracted. The method of using the endoscope hood assembly 1 is not limited to the above.
For reference, after performing the step of “pulling the pulled part 810 and fixing the other end 109 of the pulling member 100” described in (10) above, the lesion 812 and the pulled part 810 are attached to the gastrointestinal wall. Once the pulling member 100 is completely separated from 820 , a part of the other end 109 side of the pulling member 100 to which tension is applied is cut with an electric scalpel or the like to remove the lesion 812 , the pulled portion 810 , and the first clip 715 . And part of the traction member and the second clip 716 can be separated (not shown). By doing this, when the lesioned part 812 is recovered from the body, the first clip 715 and part of the traction member can be recovered together with the lesioned part 812 .

4. Effects of Endoscope Hood Assembly 1, Endoscope Hood 200, and Traction Member 100 Next, the effects of the endoscope hood assembly 1, the endoscope hood 200, and the traction member 100 will be described. It is explained below.

(1) Effect of the endoscope hood assembly 1 according to the first embodiment In the endoscope hood assembly 1 according to the first embodiment, the endoscope hood 200 accommodates the traction member 100 for traction. A traction member housing portion 220 and a third opening 203 connected to the traction member housing portion 220 are provided, and at least a portion of the traction member 100 is housed in the traction member housing portion 220 . Further, the traction member 100 is configured so that the drawer hook 140 of the traction member 100 is attached to the endoscope insertion portion 620 when the endoscope hood assembly 1 is attached to the distal end portion 621 of the endoscope insertion portion 620 . It is locked at the locking portion 230 of the endoscope hood 00 so as to be positioned forward of the distal end surface 622 (see FIGS. 2 and 3). Therefore, when forceps or a clip is protruded from the forceps opening and advanced with the claws opened, the hooks 140 for drawing out of the traction member 100 can be hooked by the claws. By further advancing the forceps or clip while hooking the drawer hook 140 , part of the traction member 100 housed in the traction member housing portion 220 is pulled out from the third opening 203 .
For this reason, if the hood assembly 1 is attached to the distal end portion 621 of the endoscope insertion portion 620, even after the endoscope insertion portion 620 is inserted into the body and the mucosal layer is incised, etc. While maintaining the state where the scope insertion portion 620 is inserted into the body, the traction member 100 can be attached to the endoscope hood assembly 1 simply by hooking forceps or a clip on the drawer hook portion 140 with a nail and moving forward. can be drawn from
Therefore, there is no need to withdraw and reinsert the endoscope insertion section 620 just to insert the traction member (thread) into the body, or insert the special traction member into the treatment instrument insertion passage again. The pulling member can be easily introduced into the body, and the pulling operation can be started immediately.
Therefore, according to the hood assembly 1 according to the first embodiment, it is possible to assist smoother traction when using an endoscope to retract the body tissue to be retracted, compared to the conventional art.

(2) Effect of Endoscope Hood 200 According to Embodiment 1 The endoscope hood 200 according to Embodiment 1 accommodates a pulling member 100 used for pulling body tissue. A portion 220 is provided, and a portion of the traction member 100 can be locked so that the drawer hook 140 of the traction member 100 is positioned forward of the distal end surface 622 of the endoscope insertion portion 620 . A locking portion 230 is provided (see FIGS. 2 and 3).
Therefore, if the traction member 100 is stored in the traction member storage portion 220 in advance, the traction member 100 can be moved forward to the third opening by hooking the drawer hook portion 140 with forceps or the claws of a clip and moving forward. It can be drawn into the body through the portion 203 .
Therefore, it is also possible to remove and reinsert the endoscope insertion portion 620 just to insert the traction member (thread) into the body as in the conventional art, or insert the special traction member 900 into the treatment instrument insertion passage 628 again. Therefore, the pulling member can be easily introduced into the body, and the pulling operation can be started immediately.
Therefore, according to the endoscope hood 200 according to the first embodiment, it is possible to assist smoother traction than in the conventional art when the body tissue to be retracted 810 is towed using an endoscope. .

(3) Effect of Storage Chamber Between Outer Peripheral Wall and Inner Peripheral Wall/Third Opening Facing Forward , and a storage chamber 222 formed between an outer peripheral wall 205 and an inner peripheral wall 206 of a substantially cylindrical endoscope hood 200. The third opening 203 is connected to the storage chamber 222, and an inner It is preferable that the opening faces the front side of the scope hood 200 .
Similarly, in the endoscope hood 200 according to the first embodiment, the traction member accommodating portion 220 is formed between the outer peripheral wall 205 and the inner peripheral wall 206 of the substantially cylindrical endoscope hood 200. It is preferable that the third opening 203 is connected to the storage chamber 222 and opens toward the front side of the endoscope hood 200 (see FIGS. 2 and 3). .).

For example, when the traction member accommodating portion 220 is configured by a recess provided in the outer peripheral wall 205, or when the third opening 203 opens on the outer peripheral wall 205 side, the recess or the third opening Since the portion 203 is exposed to the outside, when the endoscope insertion portion 620 is inserted into the body with the hood assembly 1 attached, there is a possibility that the traction member 100 will come into contact with tissue such as the oral portion. be. Further, for example, if the third opening 203 is open on the side of the inner peripheral wall 206, there is a possibility that the visual field of the endoscope camera may be obstructed when pulling out the traction member 100 from the traction member accommodating portion 220. .
On the other hand, in the hood assembly 1 according to the first embodiment, the traction member accommodating portion 220 is formed by a storage chamber 222 formed between the outer peripheral wall 205 and the inner peripheral wall 206 of the substantially cylindrical endoscope hood 200. The third opening 203 is connected to the storage chamber 222 and opens to face the front side of the endoscope hood 200 .
Therefore, when the endoscope insertion portion 620 is inserted into the body with the hood assembly 1 attached, the traction member 100 does not come into contact with tissues such as the oral cavity, and the traction member 100 does not come into contact with the tissue. The traction member 100 can be smoothly pulled out from the traction member accommodating portion 220 through the third opening 203 facing the front side of the endoscope hood 200 without obstructing the field of view of the endoscope camera. can be pulled out to

(4) Effect of cavity extending along direction parallel to central axis It is more preferable that the hood 200 has a cavity HL formed so as to extend in a direction parallel to the central axis AX1 of the substantially cylindrical shape (see FIGS. 2(c), 2(d), etc.). >>.

According to such a configuration, the traction member 100 is accommodated in the cavity HL formed in the direction parallel to the direction of the central axis AX1 of the substantially cylindrical shape (in other words, the direction parallel to the direction in which the traction member 100 is pulled out). It will be done. By housing the traction member 100 in such a cavity HL, it is possible to suppress the resistance between the traction member 100 and the inner wall forming the cavity HL when the traction member 100 is pulled out.
Therefore, by using the endoscope hood configured in this way, the traction member can be pulled out more smoothly.

(5) Effect of Traction Member Storage Portions Provided at Multiple Locations In the endoscope hood assembly 1 according to Embodiment 1, the endoscope hood 200 is provided with the traction member storage portions 220 at multiple locations. It is preferable that
Similarly, in the endoscope hood 200 according to Embodiment 1, it is preferable that a plurality of traction member accommodating portions 220 are provided (see FIGS. 2 and 3).

By configuring the endoscope hood 200 in this way, separate traction members 100 can be accommodated in the traction member accommodation portions 220 at a plurality of locations, and a plurality of traction members 100 can be accommodated in one endoscope hood 200. A traction member 100 can be incorporated.
As another mode, the one end 101 side of the traction member 100 can be accommodated in the first traction member accommodation portion, and the other end 109 side can be accommodated in the second traction member accommodation portion. By doing so, even a relatively long pulling member can be incorporated in the endoscope hood 200 .

(6) Effect of incorporating a connecting type pulling member In the endoscope hood assembly 1 described in (5) above, the pulling member 100 has at least one or more on one end 101 side and the other end 109 side. A loop portion 120 is provided, and the loop portion 120 on the one end 101 side and the loop portion 120 on the other end 109 side are connected by a connection portion 130, and the loop portion 120 on the one end 101 side and the other end 109 are connected. The side loop portions 120 are accommodated in traction member accommodation portions 220 provided at different locations, respectively, and the connection portion 130 of the traction member 100 partially straddles the second opening 202. It is preferable that the connection portion is configured as the drawer hook portion 140 (see FIGS. 2 and 3).

Here, the loop portion 120 on the one end 101 side and the loop portion 120 on the other end 109 side are respectively housed in the traction member housing portions 220 provided at different locations, and the connection portion 130 of the traction member 100 is connected to the second It is configured so as to partially straddle the inside of the opening 202 . Therefore, even if the traction member 100 is relatively long, it can be incorporated, and the connecting portion 130 (drawer hook) partially spanning the inside of the second opening 202 with forceps or a claw of a clip. 140 ), the traction member 100 can be pulled out of the traction member accommodation portion 220 .
Therefore, if such a hood assembly 1 is used, it is possible to meet the demand for procedures that require a traction member to be stretched with a relatively long traction reach.

(7) Effect of traction member 100 according to the first embodiment The traction member 100 according to the first embodiment is a traction member used when pulling a body tissue to be pulled 810 in a procedure using an endoscope. The pulling member 100 is formed by weaving fibers with high biocompatibility into an elongated shape as a whole, and has a plurality of loop portions 120 that can be hooked on the claws of a clip. 810 to be pulled by a clip hooked on the loop portion 120 so that the towed portion 810 can be pulled from the other end 109 side. It is housed in the traction member housing portion 220 provided in the endoscope hood 200 attached to the portion 621 (see FIG. 3).

Since the traction member 100 according to the first embodiment is formed by weaving fibers, the traction member expands and contracts moderately when the traction member is used for traction, so that the part to be pulled is gently stretched. can be pulled.
Moreover, since the traction member 100 has irregularities formed on its surface by woven fibers, it is more difficult to adhere to the inner wall of the digestive tract or the like compared to the case where a non-woven material is used. Therefore, it becomes a traction member that can be easily picked up by the treatment instrument.
Therefore, according to the traction member 100 according to the first embodiment, it is possible to assist smoother traction than in the conventional art when the body tissue to be retracted is retracted using an endoscope.

(8) Effect of chain-shaped loop portion In the traction member 100 described in (7) above, the traction member 100 has a plurality of loops on at least one of the one end 101 side and the other end 109 side. It is preferable that the portions 120 are configured to be continuously connected (see FIG. 3).

Constructing a plurality of loop portions to be continuously connected is, in other words, constructing a plurality of loop portions to be connected in a chain.
By configuring the traction member 100 in this way, it becomes possible to appropriately select the location of the loop to be hooked by the clip.
Therefore, even with a single traction member, the length of the traction member (traction reach) can be appropriately adjusted in a plurality of stages by appropriately selecting the location of the loop to be hooked by the clip (traction appropriate selection of reach).
In addition, if one end of the pulling member is fixed to the part to be pulled, the pulling reach can be adjusted multiple times by clipping step by step while appropriately selecting the loop location on the other end side (after the fact). dynamic traction reach adjustment).
Therefore, there is no need to insert another special traction member into the treatment instrument insertion passage for re-tensioning with another special traction member as in the conventional case, and it is possible to appropriately select the traction reach and adjust the traction reach afterwards. can be done.

(9) Effect of configuration of multiple loop portions In the traction member described in (7) or (8) above, multiple loop portions 120 are formed when the traction member 100 is placed upright on a horizontal plane. It is more preferable that the virtual planes to be formed are not on the same plane (see FIG. 3(a1)). >>.
As a specific configuration, for example, the virtual surfaces of adjacent loop portions 120 may be configured to cross each other (alternately). Alternatively, for example, only one loop portion may be configured to lie on the first plane, and a plurality of other loop portions may be configured to lie on the same second plane.

By configuring the traction member in this way, even if a part of the loop of the traction member sticks to the inner wall of the digestive tract or the like, other loops that are not on the same plane as the stuck loop are It can be floated from the inner wall without sticking to the inner wall, and the loop portion 120 indicated by FL in FIG. 》, the floating part can be hooked and picked up with treatment tools such as forceps and clips.
Therefore, it is possible to provide a traction member that is difficult to adhere to the inner wall of the gastrointestinal tract or the like and that is easy to pick up with a treatment instrument.

[Embodiment 2]
Next, an endoscope hood assembly 2 according to Embodiment 2 will be described.
FIG. 6 is a view for explaining the endoscope hood assembly 2 according to the second embodiment. FIG. 6(a) is a perspective view of the endoscope hood assembly 2, and FIG. 6(b) is a see-through perspective view of the endoscope hood assembly 2. As shown in FIG.

The endoscope hood assembly 2 according to Embodiment 2 basically has the same configuration as the endoscope hood assembly 1 according to Embodiment 1, but includes a plurality of traction members. It is different from the endoscope hood assembly 1 according to the first embodiment in that respect.

That is, in the endoscope hood assembly 2 according to the second embodiment, the endoscopic hood 200a is provided with the traction member accommodating portions 220 at a plurality of locations, and the traction member accommodating portions 220 at the plurality of locations are provided with , separate traction members 100a1 and 100a2 are accommodated (see FIG. 6).

If separate traction members 100a1 and 100a2 are housed in the traction member housing portions 220 at a plurality of locations in this manner, the traction members 100a1 and 100a2 can be pulled while the endoscope insertion portion is still inserted into the body. The 100a2 can be taken out from the endoscope hood 200a one after another, and can be used to pull a plurality of parts to be pulled.
Even if the pulling operation by the pulling member 100a1 fails once, another pulling member 100a2 built in as a backup can be taken out from the hood assembly 2 and the pulling operation can be retried.
In other words, if the hood assembly 2 is constructed in this manner, the endoscope insertion portion will not be removed to connect another string 740 as in the conventional clip pulling method, and the towed portion will not be pulled. It can be towed in multiple places. In addition, unlike the conventional special pulling member, the pulling operation can be retried while the treatment instrument is introduced into the body without repeatedly introducing another special pulling member into the treatment instrument insertion passage.

The traction member storage units 220 at a plurality of locations may store traction members having the same specifications (length, number of loops, material, etc.), or may store traction members having different specifications. You can keep it.

Although the present invention has been described based on the above embodiments, the present invention is not limited to the above embodiments. It is possible to implement it without departing from the gist thereof, and for example, the following modifications are also possible.

7A and 7B are diagrams for explaining endoscope hoods 200b and 200c according to modifications. FIG. 7(a) shows a perspective view of the endoscope hood 200b, and FIG. 7(b) shows a perspective view of the endoscope hood 200c. FIG. 8 is a view for explaining traction members 100', 100b, 100c, 100d, 100'', and 100e according to modifications. Figures 8(a) to 8(f) show traction members 100', 100b, 100c, 100d, 100'' and 100e, respectively. FIG. 9 is a view for explaining an endoscope hood assembly 3 using a traction member 100e according to a modification.

(1) The number, material, shape, position, size, and the like of the constituent elements described in the above embodiments are examples, and can be changed within the scope that does not impair the effects of the present invention.
For example, in Embodiments 1 and 2, the diagrams (see FIGS. 2, 3, and 6) having two or four traction member housing portions 220 were described, but the present invention is not limited to this. . For example, an appropriate number such as one, three, five, or the like can be selected for the traction member housing portion 220 .

(2) As the endoscope hood 200 according to the first embodiment and the endoscope hood 200a according to the second embodiment, a gap is provided between the outer peripheral wall 205 and the inner peripheral wall 206 of the substantially cylindrical endoscope hood. The storage chamber 222 thus formed constitutes the traction member accommodating portion 220, and the third opening 203 connected to the storage chamber 222 faces the front side of the endoscope hood. The storage chamber 222 is open, and the storage chamber 222 consists of a cavity HL formed so as to extend in a direction parallel to the central axis AX1 of the substantially cylindrical shape of the endoscope hood. did.

However, the invention is not limited to this. For example, as shown in FIG. 7( a ), the third opening 203 b may be provided so as to open to the outer peripheral surface of the outer peripheral wall 205 . Also, a locking portion 230b may be provided so as to correspond to the third opening 203b.
Further, a third opening may be provided so as to open in the inner peripheral surface of the inner peripheral wall 206 (not shown).
Further, as shown in FIG. 7(b), a storage chamber 222c forming the traction member housing portion 220c is configured by a cavity formed so as to extend along the circumferential direction of the substantially cylindrical endoscope hood 200c. may be

(3) The traction member 100 according to the first embodiment has five loops 120 on one end 101 side and five loops on the other end 109 side. The description has been given by taking as an example those connected by the connecting portion 130 of . Also, with regard to the individual loop portions 120, the loop portion whose outline belongs to one plane (so to speak, planar) has been described as an example.

However, the invention is not limited to this.
The loop portion 120 does not have to be five, and may be two, for example, as shown in FIG. 8(a). Alternatively, as shown in FIG. 8B, only the one end 101 side may be configured with a single loop portion 120 . Alternatively, as shown in FIG. 8C, only the one end 101 side may be configured with a loop portion 120A having a larger diameter than the loop portion 120 on the other end 109 side. Further, as shown in FIG. 8(d), the connecting portion 130a may be formed in a ring shape instead of a string shape.
Furthermore, as shown in FIG. 8(e), the loop portion 120k may be configured such that the outline of each loop portion does not belong to one plane (in other words, it has a curved shape like potato chips).

(4) The endoscopic hood assemblies of Embodiments 1 and 2 and Modification (3) have been described as examples in which when the traction member is pulled out, the whole is pulled out into the body. However, the invention is not limited to this. The one end 101 side of the pulling member may be pulled out into the body, while the other end 109 side may be arranged outside the body.
For example, as shown in FIG. 8(f), a pulling member 100e is configured by providing a plurality of continuously connected loop portions 120 on one end 101 side and connecting a lead 150 such as a thread to the other end 109 side. do. Then, while the one end 101 side of the pulling member 100 e is locked by the locking part 230 , a part of the loop part 120 closest to the one end 101 side is configured as the drawer hook part 140 . On the other hand, the endoscope hood assembly 3 is constructed by pulling out the lead 150 from the third opening 203 and making it crawl along the outside of the endoscope insertion portion 620 .
According to the endoscope hood assembly 3 and the traction member 100e configured in this manner, the lead 150 (on the side of the other end 109 of the traction member 100e) can be directly pulled from outside the body by the fingers of the operator. Therefore, the towed part can be towed while transmitting more subtle movements.

The endoscope hood and traction member disclosed in each of the embodiments and modifications can be combined in any way with respect to their respective variations and applied to the endoscope hood assembly of the present invention. can do.

1, 2, 3 ... endoscope hood assembly (hood assembly), 100, 100', 100'', 100a1, 100a2, 100b, 100c, 100d, 100e ... traction member, 101 ... (traction member ) one end, 109... the other end (of the traction member), 120, 120A, 120a, 120b, 120c, 120d, 120e, 120k, 120v, 120w, 120x, 120y, 120z... loop portion, 130, 130a... connection portion , 140... Drawer hook 200, 200a, 200b, 200c... Endoscope hood 201... First opening 202... Second opening 203, 203b... Third opening 205... (endoscopic Outer peripheral wall of speculum hood 206... Inner peripheral wall (of endoscope hood) 220, 220c... Traction member accommodating portion 222, 222c... Storage chamber 230, 230b... Locking portion 600... Endoscope Mirror 610 Operation unit 611 Button 612 Angle knob 613 Treatment instrument insertion port 620 Endoscope insertion unit 621 Distal end (of endoscope insertion unit) 622 (Endoscope 623...Forceps opening 624...Light emitting part 625...Camera lens 626...Nozzle 628...Treatment instrument insertion passage 630...External device 710...Clip 711...Claw (of clip) 712... tightening ring, 715... first clip, 716... second clip, 720... forceps, 730... wire, 740... thread, 750... knife, 800... body tissue, 810... traction site, 812... lesion site, 820 , 820a, 820b... Gastrointestinal wall 822... Mucous membrane layer 824... Submucosal layer 900... Special traction member 910... Nylon loop 912... Coil spring 914... Clip (of special traction member) 915... (Special traction member clip) spring part

Claims (12)

An endoscope hood assembly attached to the distal end of an endoscope insertion section,
It has a plurality of loops that can be hooked on the claws of the clip, and has an elongated shape as a whole. a pulling member configured to be able to pull the pulled part from
a first opening on which the distal end portion of the endoscope insertion section is fitted; and the distal end when the first opening side is fitted to the distal end portion of the endoscope insertion section. a substantially cylindrical endoscope hood having a second opening on which the treatment instrument protruding from the forceps port of the part enters and exits,
The endoscope hood is provided with a traction member housing section for housing the traction member, and a third opening connected to the traction member housing section,
At least part of the traction member is housed in the traction member housing,
Further, the traction member is such that when the endoscope hood assembly is attached to the distal end portion of the endoscope insertion portion, the drawer hook portion of the traction member is pulled out from the distal end portion of the endoscope insertion portion. is locked at the locking portion of the endoscope hood so as to be positioned forward of the surface,
When forceps or the claw of the clip as the treatment tool hooks the drawer hook of the traction member and moves forward, part of the traction member accommodated in the traction member accommodation portion is removed from the first pull member. 3 configured to be pulled out from the opening,
An endoscope hood assembly characterized by:
The endoscope hood assembly according to claim 1, wherein
The traction member accommodating portion is configured by a storage chamber formed between an outer peripheral wall and an inner peripheral wall of the substantially cylindrical endoscope hood,
An endoscope hood assembly, wherein the third opening is connected to the storage chamber and opens to face the front side of the endoscope hood. The endoscope hood assembly according to claim 1 or 2,
An endoscope hood assembly, wherein the endoscopic hood is provided with a plurality of the traction member accommodating portions. The endoscope hood assembly according to claim 3, wherein
In the traction member accommodating portions at the plurality of locations,
An endoscope hood assembly, wherein each of said separate traction members is housed. The endoscope hood assembly according to claim 3, wherein
The traction member is provided with at least one loop portion on each of the one end side and the other end side, and the loop portion on the one end side and the loop portion on the other end side are connected by a connecting portion. is formed by
The loop portion on the one end side and the loop portion on the other end side are respectively housed in the traction member housing portions provided at different locations,
The connection portion of the traction member is configured to partially straddle the inside of the second opening,
The connecting portion is configured as the drawer hanging portion,
An endoscope hood assembly characterized by: An endoscope hood attached to the distal end of an endoscope insertion section,
The endoscope hood has a substantially cylindrical shape, and has a first opening on which the distal end portion of the endoscope insertion portion is fitted, and a side of the endoscope on the side of the first opening. a second opening on which a treatment instrument protruding from the forceps opening of the distal end portion when fitted to the distal end portion of the insertion portion enters and exits;
The endoscopic hood includes a traction member accommodating portion that accommodates a traction member used for retracting body tissues, and an extraction port for the traction member that is connected to the traction member accommodation portion. A third opening is provided,
When the endoscope hood is attached to the distal end portion of the endoscope insertion portion, the drawer hook portion of the traction member is positioned forward of the distal end surface of the endoscope insertion portion. a locking portion capable of locking a part of the traction member is provided,
An endoscope hood characterized by: In the endoscope hood according to claim 6,
The traction member accommodating portion is configured by a storage chamber formed between an outer peripheral wall and an inner peripheral wall of the substantially cylindrical endoscope hood,
The endoscope hood, wherein the third opening is connected to the storage chamber and opens to face the front side of the endoscope hood. In the endoscope hood according to claim 7,
An endoscope hood, wherein the storage chamber comprises a cavity extending in a direction parallel to a central axis of a substantially cylindrical shape of the endoscope hood. In the endoscope hood according to any one of claims 6 to 8,
A hood for an endoscope, wherein a plurality of said traction member accommodating portions are provided. A traction member used when pulling a body tissue to be pulled in a procedure using an endoscope,
The traction member is
It is formed by weaving highly biocompatible fibers into a long shape as a whole,
It has multiple loops that can be hung on the claws of the clip,
One end side is clipped to the towed part by the clip hooked on the loop part so that the towed part can be towed from the other end side,
It is accommodated in a traction member accommodation portion provided in an endoscope hood attached to the distal end portion of the endoscope insertion portion of the endoscope,
A traction member characterized by: A traction member according to claim 10, wherein
A traction member, wherein the traction member is configured such that a plurality of the loop portions are continuously connected on at least one of one end side and the other end side. A traction member according to claim 10 or claim 11,
A traction member, wherein imaginary surfaces formed by the plurality of loop portions are not on the same plane when the traction member is placed on a horizontal plane.

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