CN101420914A - 多功能内窥镜检查手术器械 - Google Patents

多功能内窥镜检查手术器械 Download PDF

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CN101420914A
CN101420914A CNA2007800129398A CN200780012939A CN101420914A CN 101420914 A CN101420914 A CN 101420914A CN A2007800129398 A CNA2007800129398 A CN A2007800129398A CN 200780012939 A CN200780012939 A CN 200780012939A CN 101420914 A CN101420914 A CN 101420914A
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克劳斯·菲舍尔
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Erbe Elecktromedizin GmbH
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
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    • A61B2018/1253—Generators therefor characterised by the output polarity monopolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/142—Electrodes having a specific shape at least partly surrounding the target, e.g. concave, curved or in the form of a cave

Abstract

本发明提出了一种多功能内窥镜检查手术器械，所述器械包括：用于输送至少一种液体的输送装置；和包括钳状电极的卡钳或夹钳，所述卡钳或夹钳具有用于高频手术的夹爪，其中，所述输送装置设计成借助于在所述夹爪上或夹爪中的液体射流来剖切组织。本发明的目的在于，设计一种用于水射流手术以及用于在卡钳或夹钳上或者在卡钳或夹钳中凝结和/或切割的高频电极器械，使得所述多功能手术器械与常规高频器械或者常规卡钳或夹钳相比不会占用更多的空间。

Description

多功能内窥镜检查手术器械
技术领域
本发明涉及一种多功能内窥镜检查手术器械，具体地说，涉及一种如权利要求1的前序部分所述的用于水射流手术和高频手术应用的多功能器械。
背景技术
微创手术是用微小创口进行手术治疗的通用术语。一直以来手术治疗的目标就是术后能够在痛苦最小的情况下快速痊愈。在20世纪90年代初，腹腔镜手术和内窥镜检查手术最初只是将自己定位在简单的手术治疗，但是后来也用于实施复杂的手术。
现今，在腹腔镜手术和内窥镜术之间有所差别。就腹腔镜手术而言，它的治疗方式和开放手术方法完全一样。然而，与常规治疗相比最大的区别在于，它以明显小于开放性方法的切口到达待在其上实施手术的区域。
相比之下，就内窥镜术而言，医生能够很好地看到患者真实的体腔和空腔器官内部，识别疾病，并且可能的话就立即治疗这些疾病而无需大型手术治疗。为此，利用柔性或刚性的内窥镜检查器官和例如察看器官的黏膜。为此目的，还存在外径、长度、活检管道直径和功能不同的内窥镜。另外，所谓的内窥镜治疗如今不再专用于诊断，而是还经常用于多种疾病的治疗。
腹腔镜手术和/或内窥镜治疗典型应用于例如借助于高频(HF)手术或水射流手术有选择地进行组织分离和借助于高频卡钳或高频电极止血(凝结)或闭合血管。此外，手术卡钳还用于组织的剖切或活检切除，或者仅用于组织预处理或固定。
例如借助于水射流技术实施胃肠道中大表面积肿瘤切除的内窥镜黏膜切除(EMR)，而高频手术用于止血(凝结)。在这种情况下，用高频卡钳精准地安全闭合利用水射流技术有选择地预先从组织分离的血管。
在水射流手术中，利用非常精细的薄层状水射流，可以说是，其推开组织并形成伸展空间。通常在低压下就能够剖切软组织，从而使例如血管这样的弹性高或伸展性大的组织避开水射流伤害而得到保护。
相比之下，在高频手术中，电能转换成热能从而能够分离生物组织或止血。其中，主要利用了热效应。在高频手术电极的附近区域中60℃至70℃的温度即可导致蛋白质凝结。此处使用术语凝结。而这样的“熔接效果”能够例如止血。
在分离期间，较高的电流密度致使温度达到100℃以上，使得流体以爆发的方式蒸发、空间扩大且细胞膜“爆裂”。位于电极运动方向上的其它细胞随后也发生这种效应，从而实现了预期的组织切割或分离。
就高频手术而言，在单极应用技术和双极应用技术之间也有所差别。在单极应用技术的情况下，电流从高频手术电极经生物组织流到中性电极，中性电极通常位于患者大的表面区域上。与之相比较，在双电极应用技术的情况下，高频电流不是流过患者的身体到达中性电极。在双电极卡钳或夹钳的情况下，有缘电极和中性电极设置成彼此直接相对，因而，高频电流仅从有源电极流到中性电极。因此导致电流路径非常短，并且以低功耗限定出凝结区域。
在例如内窥镜黏膜切除手术期间，常常需要多种器械来用于组织的抓持、冲洗、分离和/或凝结并且必须在操作通道中进行相应的互换。然而，不断地互换器械需要大量时间并且明显延长手术的时长。
从DE 42 42 143 C2已知一种多功能器械，该器械包括用于双极凝结、切割和抓持的高频手动器械以及另外容置在保护管中的冲洗管和吸入管。然而，另外容置于保护管中的那些管(冲洗管、吸入管)不能够利用高频手术和水射流手术进行任何有选择的分离，并且由于它们平行于电极附接在手动器械上，所以除其它之外还需要额外的空间。
另外，DE 100 56 238 A1描述了一种器械，该器械具有用于管轴器械的夹爪机构，该器械用于除去体内的组织标本，并能够通过管轴沿最近方向吸走组织标本。张开的夹爪通道还能够用于冲洗或吸走或者用于引入凝结电极、透镜或其它手术探头。然而，在治疗期间必须相应地互换所用的器械和探头。
发明内容
因此，本发明的目的就是制造一种多功能内窥镜检查手术器械，该器械能够普遍应用且几乎不占用空间。
如权利要求1所述的器械来实现了这一目的。
具体地，此目的由一种多功能内窥镜检查手术器械实现，该多功能内窥镜检查手术器械具有：用于供给至少一种流体的供给装置；以及包括钳状电极的卡钳或夹钳，所述卡钳或夹钳具有用于高频手术的夹爪，从而供给装置形成为借助于在夹爪处或在夹爪中的流体射流剖切组织。
本发明的关键点在于，用于水射流手术及高频电极的器械形成为用于在卡钳或夹钳内或者在卡钳或夹钳处凝结和/或切割，使得所述多功能手术器械不会比常规高频器械或者常规卡钳或夹钳占用更多空间。
因此，提供一种多功能手术器械，该多功能手术器械结合了水射流手术的优点——具体地说是借助于流体射流剖切——和高频手术的优点——具体地说是在卡钳或夹钳内高频切割和热凝结，并且该多功能手术器械并不比常规的高频器械大。
因此，根据本发明的多功能器械的优点具体在于，借助于单个多功能手术器械，在治疗期间无需变换器械就能够实施有选择地进行组织的切割、抓持和热凝结。从而使与治疗时长有关的手术时间、手术成本以及患者的风险降至最小。
根据第一实施方式，多功能内窥镜检查手术器械优选包括具有刚性夹爪和可移动夹爪的钳状电极，从而供给装置形成为借助于在刚性夹爪上或在刚性夹爪中的流体射流来进行剖切。在此，刚性夹爪提供了将供给装置结合在一个夹爪中并根据应用来控制该供给装置的简单可能性。
此外，容纳所述供给装置的夹爪还包括从该夹爪远端伸出的端件，从而该供给装置的端件形成为适合于组织的剖切和/或凝结的单极电极。因此，该供给装置的端件不但作为用于组织剖切的单极高频电极，而且还作为用于通过水射流手术精确切割的出口喷嘴。
单极电极优选在供给装置端件的远端包括具体形成为圆形的盘和/或具体为半球状的附接件，其简化了沿所有方向上的高频切割。
而且，所述端件还能够相对于刚性夹爪的纵轴线移动。因此，能够根据应用情况来调节电极的长度。
在本发明的另一实施方式中，在刚性夹爪的与可移动夹爪相对的内侧上设置有供给装置的至少一个出口，使得至少一个流体射流能够沿可移动夹爪的方向排出。因此，能够以简单的方式实现精确的组织分离，这在例如局部肝脏切除的情况下是有利的。与此同时还能够用夹爪来固定组织。而且，与供给装置的出口相对的夹爪此外还提供抵御以非常高的压力排出的至少一个流体射流的保护。
在本发明的另一实施方式中，供给装置的所述至少一个出口能够相对于刚性夹爪的纵轴线移动位置。因此，流体射流能够相对于被两个夹爪固定的组织移动位置，从而有助于组织的分离。
此外，供给装置的所述至少一个出口位于刚性夹爪的凹槽中，所述凹槽设置成与多功能手术器械的纵轴线平行；和/或可移动夹爪包括设置成与多功能手术器械的纵轴线平行的凹槽，所述凹槽与供给装置的至少一个出口相对。因此，在通过流体射流进行分离和另外固定待分离组织的期间，所述至少一个出口保持畅通，并且排出的流体可以经由凹槽排出。
在本发明的另一实施方式中，卡钳或夹钳形成为活检钳，使得多功能手术器械能够专门用于活检切除。
根据本发明的多功能手术器械的夹爪还可以受弹簧元件的预应力从而保持张开。因此，夹爪只能主动闭合而由于弹簧元件的作用自动张开，所以尤其有利于抓持和凝结功能。
根据从属权利要求，本发明的其它实施方式将变得显而易见。
附图说明
下面参照基于图示更详细地阐述的示例性实施方式描述本发明。在图示中：
-图1示出多功能手术器械的实施方式的典型应用的简化图，其中借助于流体射流任意地预处理血管且随后能够分离和凝结；
-图2示出根据本发明的多功能手术器械实施方式的立体图；
-图3示出根据本发明的多功能手术器械的具有固定供给装置的另一实施方式的立体图；
-图4示出根据本发明的多功能手术器械的具有可移动供给装置的另一实施方式的立体图；
-图5示出沿图3中V-V线的截面图；
-图6示出根据本发明的多功能手术器械的形成为活检钳的另一实施方式的侧视图；以及
-图7示出根据本发明的多功能手术器械的另一实施方式的侧视图，从而刚性夹爪表现为功能部分。
具体实施方式
在以下描述中，相同的部件和具有相同作用的部件使用了同样的附图标记。
在图1和图2中所示的示例性实施方式中，示出了具有卡钳或夹钳的多功能手术器械10，卡钳或夹钳在每种情况下都具有可移动夹爪100和刚性夹爪101。夹爪100、101还形成为双极电极。圆盘状单极电极103附接到供给装置102的端件102a，供给装置102与刚性夹爪101一体形成且在图2中不能直接观看到，用于形成流体——具体地说是氯化钠(NaCl)溶液——的流体射流2。在这种情况下形成的多功能手术器械使得能够有选择地剖切例如血管周围的组织而不会损伤血管。在任意地预处理之后，血管1由卡钳或夹钳的双极电极100、101分离并通过凝结而被“熔接”。由于流动于双极电极100、101之间的较高电流及因此产生的较高温度，所以形成为电极的夹爪100、101在这种情况下用于组织的分离。另外，形成为卡钳或夹钳的夹爪100、101能够抓持或保持并且因而能够例如预处理待在其上实施手术的组织、器官或血管。根据本发明的多功能手术器械通过对器械的改动能够实现上述所有功能，进而能够明显缩短手术时间，从而使患者的风险降到最低。此外，在更有利的构造中，卡钳或夹钳能够对外界电绝缘。
另外，用于以相应的低压流体射流供给流体的装置102还可以用于注射或冲洗。根据应用，高频电极103可以形成为针、钩、刀、半球、圆盘或任何其它有利的形式。而且，高频电极103可以结合到刚性夹爪101中使其能够相对于刚性夹爪的纵轴线移动。多功能手术器械10还可以形成为刚性或柔性器械。
在图3、图4和图5中示出了本发明的另一示例性实施方式，该示例性实施方式尤其适用于组织的精确分离，例如局部肝脏切除的情况。在这种情况中，在刚性夹爪201的与可移动夹爪200相对的内侧上设置有用于流体的供给装置202的至少一个出口204，使得能够以适当的压力沿可移动夹爪200的方向排出至少一个流体射流2。在这种情况中，张开的多功能手术器械20以滑移运动沿组织的方向移动，并且所述组织被所述至少一个流体射流分开。出口204在这种情况下设置在刚性夹爪201的凹槽203中，以防止被组织阻塞。此外，可移动夹爪200还可用于保护直接邻近的组织抵御以高压排出的流体射流2从而防止穿透原位组织部分。冲击在可移动夹爪上的流体射流也由凹槽205排掉。在这种情况中，图4示出具有出口204a的实施方式，该出口204a能够相对于刚性夹爪102a的纵轴线移动位置。
图6中所示的示例性实施方式示出的多功能手术器械30具有专门形成用于活组织检查的活检钳，并且包括刚性夹爪301和可移动夹爪300。用于流体——具体地说是NaCl溶液——的流体射流2的供给装置302结合于刚性夹爪301中。供给装置302的端件302a在这种情况下从刚性夹爪302伸出，从而在端件302a的端部上形成了圆盘状单极电极303。端件302a端部处的单极电极当然还可以呈有利于高频切割的任何其它形状。在这种情况中用箭头标出活检钳的本来已知的抓持机构的功能。抓持机构的隐藏部分由虚线示出。图6中所示的根据本发明的示例性实施方式的优点在于可以利用高频手术或水射流手术有选择地分离组织部分，然后立即用活检钳30的夹爪300、301承接所分离的组织部分并将其转移走。在电流强度低的情况下，单极电极303还可用于凝结。
在图7中示出本发明的另一示例性实施方式。在这种情况中，可移动夹爪400受弹簧元件404的预应力而保持张开。而且，图7还示出穿过刚性夹爪的截面，由此能够看见结合到刚性夹爪中的用于流体射流2的供给装置402以及形成于供给装置402端部处的喷嘴405。刚性夹爪401和可移动夹爪400形成为用于使组织凝结的活检钳，并且在相应的电流强度下还能够用作高频切割电极。
附图标记
1：血管
2：流体射流
10：多功能手术器械的第一实施方式
100：可移动夹爪
101：刚性夹爪
102：流体射流供给装置
102a：供给装置端件
103：例如呈圆盘形状的高频电极
104：供给装置的出口
20：多功能手术器械的第二实施方式
200：可移动夹爪
201：刚性夹爪
201a：用于供给装置的可移位出口的刚性夹爪
202：流体射流供给装置
203：刚性夹爪的凹槽
204：供给装置的出口
204a：供给装置的可移位出口
205：可移动夹爪的凹槽
30：多功能手术器械的第三实施方式
300：可移动夹爪
301：刚性夹爪
302：流体射流供给装置
302a：供给装置的端件
303：例如呈圆盘形状的高频电极
40：多功能手术器械的第四实施方式
400：可移动夹爪
401：刚性夹爪
402：流体射流供给装置
405：喷嘴

Claims (10)

1.一种多功能内窥镜检查手术器械，其具有：
用于供给至少一种流体的供给装置；以及
卡钳或夹钳，其包括用于高频手术的带有夹爪(100、101)的钳状电极；
其特征在于，
所述供给装置(102)形成为借助于流体射流来剖切组织，并且形成在所述夹爪(100、101)中的一个处或形成在所述夹爪(100、101)中的一个内。
2.如权利要求1所述的多功能内窥镜检查手术器械，其特征在于，
所述钳状电极包括刚性夹爪(101)和可移动夹爪(100)，而所述供给装置(102)形成在所述刚性夹爪(101)处或形成在所述刚性夹爪(101)内。
3.如前述权利要求中任一项所述的多功能内窥镜检查手术器械，其特征在于，
所述供给装置的端件(102a)从所述刚性夹爪(101)的远端伸出，从而所述供给装置(102)的端件(102a)形成为适合于剖切和/或凝结组织的高频电极。
4.如前述权利要求中任一项、特别是权利要求3所述的多功能内窥镜检查手术器械，其特征在于，
所述高频电极在所述供给装置(102)的所述端件(102a)的所述远端处包括具体形成为圆形的盘(103)和/或具体为半球状的附接件。
5.如前述权利要求中任一项、特别是权利要求3所述的多功能内窥镜检查手术器械，其特征在于，
所述端件(102a)能够相对于所述刚性夹爪(101)的纵轴线移动。
6.如前述权利要求中任一项、特别是权利要求2所述的多功能内窥镜检查手术器械，其特征在于，
在所述刚性夹爪(201)的与所述可移动夹爪(200)相对的内侧上设置有所述供给装置(202)的至少一个出口(204)，使得至少一个流体射流(2)能够沿所述可移动夹爪(200)的方向排出。
7.如前述权利要求中任一项、特别是权利要求2所述的多功能内窥镜检查手术器械，其特征在于，
所述供给装置(202)的所述至少一个出口(204a)能够相对于所述刚性夹爪(101a)的纵轴线移动位置。
8.如前述权利要求中任一项、特别是权利要求6所述的多功能内窥镜检查手术器械，其特征在于，
所述供给装置(202)的所述至少一个出口(204、204a)位于所述刚性夹爪(201)的凹槽(203)中，所述凹槽(203)设置成与所述多功能手术器械(20)的纵轴线平行；和/或
所述可移动夹爪(200)包括设置成与所述多功能手术器械(20)的纵轴线平行的凹槽(205)，所述凹槽(205)与所述供给装置(202)的所述至少一个出口(204)相对。
9.如前述权利要求中任一项、特别是权利要求2所述的多功能内窥镜检查手术器械，其特征在于，
所述卡钳或夹钳形成为活检钳。
10.如前述权利要求中任一项、特别是权利要求2所述的多功能内窥镜检查手术器械，其特征在于，
所述夹爪(100、400)受弹簧元件(404)的预应力作用并因此保持张开。
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