CN103037782A - 具有可选择性地脱离的切割构件的线性切割及缝合装置 - Google Patents
具有可选择性地脱离的切割构件的线性切割及缝合装置 Download PDFInfo
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Abstract
本发明公开了一种外科缝合器械,包括可选择性地启动的切割构件。所述缝合器械可用作不切割组织的外科手术缝合器,或者如果需要,外科医生可选择性地启动所述切割构件以在部署和成形缝钉时切割组织。缝合器械可包括附接有至少一个推杆的致动器旋钮。沿远侧方向使致动器旋钮前进使得推杆对被容纳在钉仓内的缝钉施加击发运动,钉仓被支撑在缝合器械内。刀杆能够通过选择器开关而选择性地联接至致动器旋钮,选择器开关可从致动位置运动至未致动位置,在致动位置中,致动器旋钮沿远侧方向的运动使具有切割刀片部分的刀杆前进至钉仓中的缝钉排之间,而在未致动位置中,致动器旋钮的运动使推杆前进但不使刀杆前进。
Description
背景技术
技术领域
本发明涉及缝合器械,并且在多个实施例中涉及用于产生一排或多排缝钉的外科切割及缝合器械。
背景技术
近年以来,外科医生越来越倾向于使用缝合器械来缝合身体组织,例如肺、食道、胃、十二指肠和/或肠道中的其它器官。在许多情况下,使用适当的缝合器械可用更短的时间将手术做得更出色,并简化此前困难的外科手术,例如胃肠吻合术。早先的直线双排和四排切割缝合器包括将缝钉单独手动加载到其中的无钉仓器械。其它早先的器械包括预消毒的一次性缝钉加载单元和切割构件,其可用于同时分割组织并将缝钉排成形。这种外科缝合器的实例公开于在1970年3月10公布的名称为“INSTRUMENTFOR PLACING LATERAL GASTROINTESTINAL ANASTOMOSES”的美国专利3,499,591中,该专利的全部公开内容以引用的方式并入本文。
缝合器械可包括一对相配合的细长钳口构件,其中每个钳口构件均可用于插入待吻合的内部管状身体器官内。在多个实施例中,钳口构件中的一个可支撑具有至少两个横向间隔的缝钉排的钉仓,同时另一个钳口构件可支撑与钉仓中的缝钉排对准的具有缝钉成形凹腔的砧。一般来讲,缝合器械还可包括可相对于钳口构件而滑动的推杆与刀片组件,以通过推杆上的凸轮表面将缝钉从钉仓中依次顶出。在至少一个实施例中,凸轮表面可被构造成启动由钉仓承载并与各个缝钉关联的多个缝钉驱动器,以推压缝钉靠在砧上并在夹在钳口构件之间的组织内形成横向相间的变形缝钉排。然而,在典型的缝合器械中,一旦将钳口构件组装在一起就无法相对于钉仓移动砧,并且无法调整已形成的缝钉高度。在至少一个实施例中,刀片可跟随推杆并沿缝钉排之间的路线切割组织。然而,刀片及推杆一般构成一个组件,从而使推杆与刀片二者被同时致动。此类缝合器械的实例公开于在1984年2月7日公布的名称为“SURGICAL INSTRUMENTS”的美国专利4,429,695中,该专利的全部公开内容据此以引用方式并入本文。线性缝钉及钉仓的其它实例公开于2010年3月17日提交的序列号为12/725,993、名称为“STAPLE CARTRIDGE”的美国专利申请中,该专利申请的公开内容全部以引入方式并入本文。
在某些外科手术中,不需要在缝合过程中切割组织。在许多现有的线性缝合装置中,在切割构件被驱动穿过组织时击发缝钉。因此,需要一种具有可选择性脱离的切割构件的线性切割及缝合装置,以使外科医生可使用所述装置在不切割组织的情况下安装缝钉,并且还能够在需要时切割组织。
上述讨论仅仅是为了举例说明本发明所属技术领域内目前存在的一些不足,而不应看作是对权利要求范围的否定。
发明内容
在本发明的至少一种形式中,提供了一种外科器械。在多个实施例中,所述外科器械包括第一钳口构件,所述第一钳口构件能够可操作地支撑钉仓,在所述钉仓中支撑有多个缝钉。第二钳口构件能够可拆卸地联接至所述第一钳口构件,以使组织能够被夹紧在所述第一钳口构件和所述第二钳口构件之间。至少一个推杆组件相对于第一钳口构件被可操作地支撑,并能够在所述至少一个推杆组件在钉仓中朝远侧前进时对支撑在钉仓中的缝钉选择性地施加击发运动。能够对夹紧在第一钳口构件与第二钳口构件之间的组织进行切割的刀杆相对于第一钳口构件及所述至少一个推杆组件被可操作地支撑。选择器开关可操作地与刀杆交接,并可在启用位置与禁用位置之间运动;在启用位置中,对所述至少一个推杆组件施加启动运动使刀杆及所述至少一个推杆组件在第一钳口构件内沿远侧方向同时运动,在禁用位置中,对所述至少一个推杆组件施加启动运动使所述至少一个推杆组件沿所述远侧方向运动而不使刀杆沿所述远侧方向运动。
根据本发明的其它一般方面,提供一种用于与外科缝合器械一起使用的外科钉仓,所述外科缝合器械具有端部执行器,所述端部执行器具有用于将组织夹紧在其间的第一钳口构件及第二钳口构件。所述外科缝合器械还具有用于产生切割运动的刀杆组件以及用于产生缝钉击发运动的推杆装置,所述缝钉击发运动独立于所述切割运动。所述钉仓的多个实施例包括仓主体,所述仓主体能够被可运动地支撑在端部执行器中。所述仓主体可操作地支撑多个缝钉,所述缝钉被定向成多个纵向延伸的排,并能够在对缝钉施加缝钉击发运动时从仓主体被顶出。切割刀片被可操作地支撑在仓主体中,并可在对切割刀片施加切割运动时从位于仓主体的第一端部处的未致动位置选择性地运动至位于仓主体的第二端部处的致动位置。切割刀片能够在对所有缝钉施加击发运动期间选择性地保持在未致动位置,并在对切割刀片施加切割运动时从未致动位置运动至致动位置。
附图说明
通过结合附图参考本发明实施例的以下说明,本发明的上述和其它特征及优点及其实现方法将会变得更加明显,并可更好地理解发明本身,其中:
图1是本发明的缝合器械的实施例的立体视图;
图2是显示已被局部拆解的图1所示缝合器械的侧正视图,其中带有砧的上钳口构件已从带有钉仓的下钳口构件分离;
图3是显示图1所示缝合器械处于组装构型的侧正视图;
图4是图1所示缝合器械沿图1中的线4-4截取的横截面图,其显示用于使上钳口构件的后部与下钳口构件的后部分开的凸轮机构;
图5是图1所示缝合器械的带有砧的钳口构件的底视图;
图6是图1所示缝合器械的带有钉仓的钳口构件的顶视图;
图7是图1所示缝合器械的底视图;
图8是图1所示缝合器械的前端视图;
图9是图1所示缝合器械的后端视图;
图10是图1所示缝合器械的推杆与刀片组件的立体视图;
图11是推块及致动器旋钮的立体视图,所述推块及致动器旋钮是图10所示推杆与刀片组件的元件;
图12是推块的一部分的局部横截面图,其中刀选择器开关处于禁用位置;
图13是图12所示推块的部分的另一局部横截面图,其中刀选择器开关处于启用位置;
图14是本发明实施例的推块及刀杆的一部分的横截面图;
图15是图1所示缝合器械的后部的局部横截面图,其显示凸轮机构处于其非工作位置;
图16是图1所示缝合器械的后部的局部横截面图,其显示凸轮机构处于其工作位置;
图17是图1所示缝合器械的钉仓的侧视图;
图18是本发明的钉仓实施例的顶视图;
图19是图18所示钉仓的底视图;
图20是图5及图6所示带有砧的钳口构件及带有钉仓的钳口构件的局部横截面图,其显示图10所示推杆与刀片组件的操作;
图21是本发明另一钉仓实施例的侧正视图;
图22是图21所示钉仓实施例的顶视图;
图23是本发明另一钉仓实施例的侧正视图;
图24是本发明实施例的切割刀片与刀杆结构的局部透视图;以及
图25是本发明另一实施例的切割刀片与刀杆结构的局部透视图。
在所述这些图式中,对应的参考符号均表示对应的部件。本文示出的范例以一种形式示出本发明的优选实施例,不应将这种范例理解为是以任何方式限制本发明的范围。
具体实施方式
现在将描述某些示例性实施例,以从整体上理解本文所公开的装置和方法的结构原理、功能、制造和用途。这些实施例的一个或多个实例在附图中图解说明。本领域的普通技术人员将会理解,本文特别描述和在附图中示出的装置和方法为非限制性的示例性实施例,并且本发明各种实施例的范围仅由权利要求书限定。就一个示例性实施例进行图解说明或描述的特征,可与其它实施例的特征组合。这种修改形式和变化形式旨在包括在本发明的范围之内。
本说明书通篇提及的“多个实施例”、“一些实施例”、“一个实施例”或“实施例”等,是指结合所述实施例描述的具体特征、结构或特性包括在至少一个实施例中。因此,本说明书通篇出现的短语“在多个实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。此外,在一个或多个实施例中,具体特征、结构或特性能够以任何合适的方式结合。因此,在没有限制的情况下,结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施例的特征、结构或特性相结合。这种修改形式和变化形式旨在包括在本发明的范围之内。
本文所用术语“近侧”和“远侧”是相对于操纵外科器械的柄部的临床医生而言的。术语“近侧”是指最靠近临床医生的部分,术语“远侧”则是指远离临床医生的部分。还应当理解,为方便和清楚起见,本文可结合附图使用例如“垂直”、“水平”、“上”和“下”之类的空间术语。然而,外科器械能够在许多取向和位置使用,并且这些术语并非限制性的和/或绝对的。
结合本发明的多个实施例参见图1及图2,线性缝合器械(总体上标记为20)包括带有砧的细长上钳口构件22及带有钉仓的细长下钳口构件24。此种类型的示例性缝合器械公开于名称为“SURGICAL STAPLINGINSTRUMENT WITH IMPROVED FIRING TRIGGER ARRANGEMENT”的美国专利申请公布US2009/0200355A1中,该专利申请公布全文以引入方式并入本文。在所示的实施例中,带有砧的上钳口构件22由柄部26进行支撑,其中钳口构件22的前部从钳口构件22向前延伸。带有钉仓的下钳口构件24由柄部28支撑,其中钳口构件24的前部从钳口构件24向前延伸。如图3所示,上柄部26及下柄部28的形状适于形成手抓握部,以利于由外科医生握持及操作缝合器械。出于此种目的,在每个柄部上设置有扩大的前凸起27及小的后凸起29。在多个实施例中,柄部26及28可由例如塑料或其它轻质材料制成,而钳口构件22及24可由例如不锈钢或其它类似材料制成。
如图5所示,在多个实施例中,“第二”钳口构件或上钳口构件22包括一体式细长槽形框架,所述一体式细长槽形框架包括由顶壁31连接的一对相对的细长侧壁30。上柄部26包括邻近其前端而位于上柄部内的一对垂耳32。上钳口构件22包括槽34(图4),槽34形成于沿上钳口构件22的顶壁31的中间位置,垂耳32可穿过槽34向下凸伸。锁销36延伸穿过形成于上钳口构件22的侧壁30中的孔及穿过形成于垂耳32中的孔,以将上钳口构件可枢转地连接至上柄部26。
参见图5,在多个实施例中,上钳口构件22的前部具有一对向内延伸的细长凸缘38,所述一对凸缘38界定缝合器械的砧40。凸缘38由沿砧40的整个长度延伸的中心纵向槽42分开。在中心槽42的近端处,凸缘38设置有向内倾斜的导向面41。在多个实施例中,每个凸缘38具有纵向的两排均匀相间的缝钉成形凹腔44。参见图4及图5,锥形砧顶端46安装在带有砧的钳口构件22的前面,以利于将钳口构件插入例如中空的管状身体器官中。砧顶端46包括细长主体48(图4),细长主体48可插入穿过砧40上方的由上钳口构件的侧壁30及凸缘38所界定的纵向通道。该细长主体48可在锁销36上方的垂耳32之间延伸,并可包括位于垂耳32后面的扩大的后部50,以将砧顶端46在上钳口构件22上固定。
参见图2及图6,在多个实施例中,带有钉仓的“第一”钳口构件或下钳口构件24包括一体式细长槽形框架,所述一体式细长槽形框架包括由底壁53连接的一对相对的细长侧壁52。沿下钳口构件24的后部,一对相间的细长直立侧部凸缘54(图2)可从其相对的侧壁52向上延伸。如图5及图6所示,在至少一个实施例中,下钳口构件24在其侧部凸缘54之间的宽度大于上钳口构件22在其侧壁30之间的宽度,以在组装缝合器械以便进行手术时使上钳口构件的后部能够被容纳在下钳口构件的侧部凸缘54之间。如图2所示,下钳口构件24的每个侧部凸缘54均包括垂直凹口56,所述垂直凹口的位置与上钳口构件22上的锁销36对齐。在组装上钳口构件22与下钳口构件24时,锁销36的相对两端可被容纳在凹口56中。
如图2及图6所示,下钳口构件24能够支撑钉仓60,所述钉仓适于接纳多个外科缝钉61(图20),所述缝钉61排列成至少两个在横向上间隔开的纵向排。钉仓60可在下钳口构件24的侧壁52之间安装在下钳口构件24的前部。钉仓60被中心细长槽62(图6)沿纵向分割,中心细长槽62从钉仓的第一端部或近端67朝其第二端部或远端69延伸。在多个实施例中,形成于钉仓60中的多个缝钉开口64可排列成两对在横向上相间的排,其中每一对均设置在中心纵向槽62的相对两侧。多个外科手术用缝钉61(图20)安装在钉仓60的开口64内。如图6所示,相邻的排中的缝钉开口64相互交错,以在操作所述器械时对组织提供更有效的缝合。参见图18及图19,钉仓60可包括一对纵向槽66,所述一对纵向槽位于细长中心槽62的相对两侧并在中心槽每一侧上设置在交错的各排开口64之间。每个中心槽66可从钉仓60的近端67朝其远端69延伸。
如图20所示,在多个实施例中,多个缝钉驱动器65可滑动地安装在缝钉开口64中,以用于致动被装载于钉仓60中的缝钉61。参见图6,每个缝钉驱动器65可被设计成同时致动在钉仓60中位于相邻排中的两个缝钉61。因此,在多个实施例中,第一组缝钉驱动器65用于致动位于中心纵向槽62的一侧上的交错排中的缝钉61,第二组缝钉驱动器65则可用于致动位于中心纵向槽62的另一侧上的一对相邻排中的缝钉61。
参见图2,缝合器械20的多个实施例包括闩锁机构(总体上标记为90),以用于沿上钳口构件22及下钳口构件24在中间位置将上钳口构件22与下钳口构件24闩锁在一起。在多个实施例中,钳口构件22及24可在邻近砧40及钉仓60的近端的位置处闩锁在一起。在至少一个实施例中,闩锁结构90包括锁臂92(图2),锁臂92通过枢轴销80(图4)可枢转地连接至下钳口构件24。锁臂92可为槽形构型并可包括一对相对的细长侧壁94(图6),所述一对相对的细长侧壁间隔开一距离,该距离足以横跨下钳口构件24的侧壁52。锁臂92的每个侧壁94均包括向上及向前延伸的钩构件96,所述钩构件设置有用于接纳锁销36的朝前的槽98。覆盖物100安装在锁臂92的下表面上。当锁臂92闭合时,如图3所示,覆盖物100可与下柄部28的底部对齐,以利于由外科医生握持及操作缝合器械20。在多个实施例中,覆盖物100可由例如塑料或其它轻质材料制成,而锁臂92可由例如不锈钢制成。如图7所示,覆盖物100可包括从其相对两侧向外延伸的细长凸缘102及104,所述细长凸缘可用作手指抓握部,以使锁臂92能够从其被闩锁位置向下枢转至其未被闩锁位置。当锁臂92运动至其闭合位置或闩锁位置时,钩构件96的槽98的表面与锁销36(其用作偏心闩锁)相配合以将锁臂92保持于其闩锁位置。
参见图6及图10,缝合器械20的多个实施例包括改良的推杆及可选择性啮合的刀杆组件(总体上标记为110),所述组件能够被可滑动地安装以分别相对于上钳口构件22及下钳口构件24进行纵向运动,从而将缝钉61从钉仓60驱动或“击发”至夹在这些钳口构件之间的组织内。当缝钉被击发时,缝钉穿过被夹紧在各钳口构件之间的组织而被驱动至砧40内。如果需要,外科医生也可沿在组织中形成的缝钉排之间的一条线来切割组织。在多个实施例中,推杆与刀片组件110包括推块112(图6),推块112能够被可滑动地容纳在下槽形钳口构件24内的其直立侧部凸缘54之间。如图10及图11所示,推块112具有致动器旋钮114,所述致动器旋钮包括凸缘部116,所述凸缘部通过例如粘结剂、焊接、按扣结构、凸缘等附接到推块112。致动器旋钮114的凸缘116可延伸穿过在下钳口构件24的一个侧部凸缘54中形成的细长槽122(图2)并沿细长槽122行进。
在多个实施例中,推杆与刀片组件110还包括一对缝钉推杆124(图10),所述一对缝钉推杆从推块112向前凸伸并被可滑动地容纳在钉仓60的细长槽66(图19)中。在某些实施例中,推块112具有一对垂直槽126(图11),推杆124被固定在所述一对垂直槽126中。在所示实施例中,例如采用两个推杆124。此种结构用于有利于致动多排缝钉,这将在下文中进行更详细说明。然而,也涵盖采用至少一个推杆以及多于两个推杆的其它实施例。如图10所示,每个缝钉推杆124的前端均具有楔形顶端128,所述楔形顶端界定倾斜的凸轮表面130,以用于在使推杆前进至钉仓60中时接合缝钉驱动器65。如图20所示,每个缝钉驱动器65均设置有斜面132,所述斜面被定向成与每个缝钉推杆124的凸轮表面130具有相同的角度,以在这些表面之间实现平坦的滑动接触。当推杆124穿过钉仓朝远侧运动时,它们会接触缝钉驱动器65以对其施加“击发运动”,从而使驱动器将缝钉运动至与砧40形成接触。
如在图10至图14中可见,可选择性啮合的刀片组件110的多个实施例包括可滑动的刀选择器开关300。在某些实施例中,推块112具有纵向槽302,所述纵向槽的尺寸被设定成可滑动地接纳刀支撑杆136。刀选择器开关300包括选择器杆304,所述选择器杆可在推块112中的横向槽310中沿横向滑动,并能够与刀支撑杆136的近端部分320进行保持性接合及分离。参见图10和图11。在多个实施例中,选择器杆304中具有槽330,所述槽能够可滑动地接纳刀支撑杆136的近端部分320,在近端部分320上具有钩状构造322。参见图12和图13。因此,当选择器杆304沿横向滑动至图12所示的禁用位置时,选择器杆304中的槽330对齐,以使推块112相对于刀杆136滑动。这样,当选择器杆304处于禁用位置时,外科医生可沿远侧方向“DD”滑动推块112,以使推杆124朝远侧前进而不使刀杆136前进。当外科医生希望切割组织时,将选择器杆304沿横向滑动至图13所示的启用位置中。当处于此位置时,钩状构造322与选择器杆304接合,从而使推杆112沿远侧方向“DD”的运动使刀杆136随推杆124一起沿远侧方向前进。同样,当外科医生沿近侧方向“PD”移动推杆112时,刀杆136也沿近侧方向运动以回缩出钉仓60之外。
在某些实施例中,如在图4、图10及图20中可见,具有斜切割刃140的倾斜刀片138被形成至或以其它方式附接至刀杆136的远端137。刀片138的斜切割刃140可被定向成相对于细长钳口构件22及24成一角度,并可被可滑动地容纳在钉仓60的中心纵向槽62中。在其它实施例中,可在钉仓60'中设置单独的刀片438。参见图21和图22。在此种实施例中,例如,钉仓60'可与上述钉仓60基本上相同,只是钉仓60'中包括可纵向运动的刀片438。在此种实施例中,钉仓60'上可形成有覆盖物440或附接有覆盖物(如图23所示),以在使用之前包含刀片438的切刃。刀片438是以中心细长槽62(图22)进行可滑动地定向,并能够在被刀杆136'的远端接触时沿远侧方向DD驱动。参见图24。当使用此种实施例时,一旦刀片438已沿远侧前进至中心细长槽62的远端,则当外科医生将推块122及刀杆136'以及推杆124回缩时,刀片438将保持在此位置。因此,外科医生可将用过的钉仓60'丢弃,并使用具有新刀片438'的新钉仓,最终可使用或不使用新刀片438'。在替代实施例中,刀片438可设置有钩结构450,所述钩结构适于接合刀杆136"的远端460上的钩结构462。参见图25。
根据本发明的多个实施例,缝合器械20可设置有钳口夹紧装置以用于对钳口构件施加夹紧力,从而在缝钉61的成形期间将钉仓60与砧40推动至一起。所述钳口夹紧装置可包括用于使钳口构件在远离闩锁机构的位置处分开的装置,以在缝钉61成形时抵抗施加在钉仓60和砧40上的力。在至少一个实施例中,凸轮装置可安装在其中一个所述钳口构件上,并可与另一钳口构件接合,以将所述钳口构件在远端位置处分开,从而将钉仓60与砧40推动至一起。在多个实施例中,可在远离闩锁机构的位置处在其中一个钳口构件上可枢转地安装凸轮构件。凸轮构件可从第一非工作位置枢转至第二工作位置,以使这些钳口构件的远端分开。凸轮构件可由推杆与刀片组件110的推块112操作,以在使推块前进时运动至其工作位置、并在推块被回缩时返回至其非工作位置。
在多个实施例中,凸轮机构(总体上标记为150)可定位在下钳口构件24的后端附近,如图4所示。凸轮机构150可包括可枢转地安装在横向枢轴销154上的凸轮构件152,所述枢轴销在下钳口构件24的直立侧部凸缘54之间延伸。凸轮构件152可包括:第一下凸轮表面156,其用于在凸轮构件152的第一非工作位置(图15)上使上钳口构件22的顶壁31接合凸轮152;以及第二上凸轮表面158,其用于在凸轮构件152处于其第二工作位置(图16)时使上钳口构件22的顶壁31接合凸轮152。第一凸轮表面156可被布置成在凸轮152的非工作位置中使上钳口构件及下钳口构件保持基本上平行于凸轮152。第二凸轮表面158可被布置成当凸轮152从其非工作位置枢转至其工作位置时,将上钳口构件22的后端抬高例如约0.125英寸(3.2mm)。另外,上钳口构件22可具有足够的挠性,以在凸轮构件152从其工作位置运动至其工作位置时允许上钳口构件22的后部远离下钳口构件24而向上弯曲。
如图4所示,凸轮构件152可包括沿径向延伸的凹口160,所述沿径向延伸的凹口将凸轮划分成大的前部指状物162和小的后部指状物164。前部凸轮指状物162可包括平的、朝后的表面165,并且后部凸轮指状物164可包括倾斜的、朝前的表面166。当凸轮152处于其非工作位置时,前部凸轮指状物162和后部凸轮指状物164可经由形成于下钳口构件24的底壁53中的细长槽168而向下延伸。
在多个实施例中,凸轮构件152能够由推块112操作,以在使推块前进时从其非工作位置运动至其工作位置。如图11所示,推块112具有自其突出的凸轮致动器销174。参见图4及图11,当凸轮构件152被设置在其非工作位置时,凸轮致动器销174被容纳在凸轮构件的前部指状物162与后部指状物164之间的凹口160中。
如图15所示,当凸轮构件152被设置在其非工作位置时,上钳口构件22的顶壁31可倚靠凸轮构件的第一凸轮表面156。当凸轮构件152处于其非工作位置时,上钳口构件22的顶壁31可基本上平行于下钳口构件24的底壁53。另外,推块112可位于其起始位置。当推块112如箭头182所示(图13)前进时,凸轮致动器销174可接合前部凸轮指状物162的后表面165,以使凸轮构件152沿逆时针方向旋转(如箭头184所示),从而使凸轮构件枢转至其第二工作位置并使其第二凸轮表面158运动至与上钳口构件22的顶壁31接合。在凸轮构件152枢转至其工作位置的情况下,上钳口构件22的顶壁31可远离下钳口构件24的底壁53向上弯曲,如箭头186所示。凸轮构件可对上钳口构件22及下钳口构件24施加力,所述力使这些钳口构件的后部弯曲分开。由于上钳口构件22的后部与下钳口构件24的后部弯曲分开,因此可对上钳口构件22的前部及下钳口构件24的前部施加额外的夹紧力,以将砧40及钉仓60抵靠被夹在这些钳口构件之间的组织而夹紧。因此,当推杆与刀片组件110前进以使缝钉61成形以及切割组织时,砧40与钉仓60可一起被推动,以抵抗施加在砧与钉仓上的力。
参见图16,当在缝钉61成形之后使推块112回缩时,凸轮致动器销174可接合后部凸轮指状物164的倾斜表面166,以使凸轮构件152沿顺时针方向枢转。随着凸轮致动器销174沿倾斜表面166运动至凹口160内,凸轮构件152可沿顺时针方向枢转并返回其第一非工作位置(图15),此时其第一凸轮表面156接合钳口构件22的顶壁31。因此,由凸轮152施加在上钳口构件22及下钳口构件24的后部上的力可被释放,并且上钳口构件22的顶壁31可恢复至与下钳口构件24的底壁53基本上平行的关系。相似地,施加在钳口构件22及24的前部的夹紧力也可被释放,以松开砧40及钉仓60的夹持。
在多个实施例中,缝合器械20可包括安装在其中一个所述钳口构件上的间隔装置,以在缝合器械的钉仓60与砧40之间维持预定间隙。参见图4及图6,此间隔装置可被实施为间隔销190,所述间隔销邻近钉仓60的远端进行安装。间隔销190可从下钳口构件24的底壁53穿过钉仓60垂直地向上延伸,并从钉仓的顶部向上突出预定的距离。如图5所示,砧40的一个凸缘38可包括邻近其远端的凸缘区段192,以用于接合间隔销190。在缝合器械已组装好而准备进行操作时(图4),间隔销190可接合凸缘区段192,以在砧40与钉仓60之间维持预定的间隙。
在缝合器械20的操作过程中,所谓的“目标组织”在初始时被置于钳口构件22和24之间并被这些钳口构件夹紧。因此,通过使锁臂92向下枢转运动至其未被闩锁位置(图2),可将柄部26及28解锁。因此,锁销36的相对两端可从在锁臂92的钩构件96中形成的槽98中脱离。此后,可通过使锁销36从在下钳口构件的侧部凸缘54中形成的槽56脱离而使上钳口构件22与下钳口构件24分离。
接着,将目标组织置于钳口构件22和24上。例如,如图20所示,可将管状的肠组织滑动至每个钳口构件的前部上。在将组织置于钳口构件上之后,可对缝合器械20进行重新组装。可通过使锁销36对准在下钳口构件24的直立侧部凸缘54中形成的垂直槽56来实现重新组装。之后,可将下钳口构件24的侧部凸缘54定位在上柄部26内并跨越上钳口构件22的侧壁30,同时可将锁销36的相对两端插入垂直槽56内。最后,可将锁臂92向上枢转至其闩锁位置(图3),此时其上盖100与下柄部28的底部齐平。因此,钩构件92可枢转到锁销36上并且槽98可接纳锁销的相对两端。因此,上钳口构件22与下钳口构件24可邻近砧40及钉仓60在其中间位置处被闩锁在一起。另外,间隔销190可穿过身体组织而接合砧40的凸缘区段192,以在砧40与钉仓60之间维持预定的间隙。
在将组织夹紧在钳口构件之间后,外科医生可接着决定是否想要切割及缝合所述组织或者是否希望缝合所述组织而不切穿所述组织。如果外科医生希望切割所述组织,则将选择器杆304沿横向运动至启用位置(图13)。然后,可通过使致动器旋钮114前进以致动推杆与刀片组件110来击发缝合器械20。参见图20,在推块112的初始前进期间,推杆124朝远侧滑动,并且推杆的楔形顶端128开始前进经过钉仓60的槽66。随着推块112沿远侧方向“DD”前进,其凸轮致动器销174接合前部凸轮指状物162的后表面165,以使凸轮152沿逆时针方向枢转(如图16的箭头184所示),从而使凸轮构件的第二凸轮表面158运动至与上钳口构件22的顶壁31接合。凸轮构件152可对上钳口构件22及下钳口构件24施加力,所述力使这些钳口构件的后部弯曲分开。因此,上钳口构件22的顶壁31的后端可相对于下钳口构件24的底壁53的后端而向上弯曲例如约0.125英寸(3.2mm)。钳口构件22及24的后端弯曲分开可致使额外的夹紧力施加在钳口构件的前部上,以将砧40与钉仓60抵靠被夹于钳口构件之间的组织而夹紧。这些额外的夹紧力趋于抵抗施加在砧40及钉仓60上的力,同时组织受到切割且缝钉61抵靠40而成形,以在砧40与钉仓60之间维持所需的间距,从而形成高度基本上均匀的成形缝钉61。
随着推块112前进,缝钉推杆124可在纵向上沿设置在钉仓60中的槽66运动。缝钉推杆124的两个楔形凸轮表面130可穿过槽66而运动至与缝钉驱动器65的倾斜表面相接合,以从钉仓60中依序驱动各缝钉61并将缝钉61抵靠砧凸缘38而成形为B形构形。各凸轮表面130可位于距推块112同一距离处,以同时致动位于中心纵向槽62的相对两侧上的缝钉驱动器65。同时,刀片138穿过砧40的中心纵向槽42及钉仓60的中心纵向槽62前进,以切割夹在钳口构件之间的组织。通过凸轮机构150而施加至上钳口构件22与下钳口构件24的前部上的额外夹紧力可趋于抵抗在缝钉61成形时施加在砧40和钉仓60上的力。
在使推块112完全前进而使钉仓60中的所有缝钉成形后,可通过致动器旋钮114的回缩而使推块112朝其起始位置回缩。因此,缝钉推杆124及刀片138同时从钉仓60及砧40回缩。
随着推块112朝其起始位置返回,凸轮致动器销174可接合后部凸轮指状物164的倾斜表面166,以使凸轮构件152沿顺时针方向朝其非工作位置枢转。凸轮致动器销174可沿倾斜表面166运动至凸轮指状物162与164之间的槽160内,以使凸轮构件152返回至其非工作位置。因此,凸轮构件152的第二凸轮表面158可从上钳口构件22的顶壁及上钳口构件22的顶壁31的后端脱离,并向下运动至与第一凸轮表面156接合。同时,前部凸轮指状物162可向下枢转。之后,在凸轮构件152处于其非工作位置的情况下,可如图2所示将锁臂92向下枢转,以允许将上钳口构件22与下钳口构件24拆解开。此时,便可从钳口构件移开被切割及缝合的组织。
对于那些不需要对组织进行切割的手术,外科医生将选择器杆304运动至禁用位置(图12)。当处于此位置时,推块122可在刀杆136上沿远侧方向纵向前进,而不使刀杆136朝远侧前进。因此,推块122的运动会以上述方式启动缝钉推杆124,但刀片138不会切割组织。因此,这些实施例使外科医生具有能够缝合组织但不切穿组织的更大灵活性。另外,本发明的多个实施例包括钉仓及新的切割刀片,所述钉仓中可操作地支撑有多排缝钉,可使用或不使用所述新切割刀片。如果外科医生希望在缝钉击发期间切割组织,则将选择器杆运动至启用位置并使推杆前进。一旦已对组织进行切割且缝钉已被击发,便可将钉仓弃置。此种结构使得通过使用包含新刀片的新钉仓,可对所述外科器械重复使用。其它实施例则采用可重复使用的刀片结构。
可将本发明所公开的装置设计为单次使用后即被弃置,或者可将它们设计为可多次使用。然而,在任一种情况下,所述装置均可进行修复,以在至少一次使用后再次使用。重新恢复可包括如下步骤的任意组合:拆卸该装置、然后清洗或置换某些部分以及随后重新组装。特别是,所述装置可以拆卸,而且可以任意组合选择性地置换或移除该装置的任意数目的特定零件或部分。清洗和/或置换特定部分后,该装置可以在修复设施处重新组装以便随后使用,或者在即将进行外科手术前由外科手术团队重新组装。本领域的技术人员将会知道,装置的修复可利用多种用于拆卸、清洗/置换和重新组装的技术。这些技术的使用以及所得的修复装置均在本发明的范围内。
优选地,在手术前处理本文所述的器械。首先,获取新的或用过的器械,并在必要时对器械进行清洁。然后对器械进行消毒。在一种消毒技术中,将器械置于密闭容器中,例如塑料或TYVEK袋中。然后将容器和器械置于能够穿透该容器的辐射区,例如γ辐射、x射线或高能电子。辐射将器械上和容器中的细菌杀死。然后将灭菌后的器械保存在消毒容器中。该密封容器使器械保持无菌直到在医疗设施中打开该容器为止。
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料都仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。由此,在必要的程度下,本文所明确阐述的公开内容将取代以引用方式并入本文的任何冲突材料。任何以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
尽管已经将本发明作为示例性设计进行了描述,但还可以在本公开的精神和范围内对本发明进行修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型型式、用途或修改型式。此外,本专利申请旨在涵盖本发明所属领域中属于已知或惯有实践范围内的与本公开不同的型式。
Claims (18)
1.一种外科器械,包括:
第一钳口构件,所述第一钳口构件能够可操作地支撑钉仓,所述钉仓中具有多个缝钉;
第二钳口构件,所述第二钳口构件能够可拆卸地联接至所述第一钳口构件,以使组织被夹紧在所述第一钳口构件与所述第二钳口构件之间;
至少一个推杆组件,所述至少一个推杆组件相对于所述第一钳口构件被可操作地支撑,并能够在使所述至少一个推杆组件穿过所述钉仓而朝远侧前进时对被支撑在所述钉仓中的缝钉选择性地施加击发运动;
刀杆,所述刀杆相对于所述第一钳口构件和所述至少一个推杆组件被可操作地支撑,所述刀杆能够切割被夹紧在所述第一钳口构件和所述第二钳口构件之间的组织;以及
选择器开关,所述选择器开关可操作地与所述刀杆交接,并能够在启用位置和禁用位置之间运动,在所述启用位置中,对所述至少一个推杆组件施加启动运动使所述刀杆和所述至少一个推杆组件在所述第一钳口构件内沿远侧方向同时运动,在所述禁用位置上,对所述至少一个推杆组件施加所述启动运动使所述至少一个推杆组件沿所述远侧方向运动而不使所述刀杆沿所述远侧方向运动。
2.根据权利要求1所述的外科器械,其中所述刀杆和所述至少一个推杆组件由推块可操作地支撑,所述推块被可运动地支撑在所述第一钳口构件的一部分内,所述推块与所述选择器开关可操作地交接。
3.根据权利要求2所述的外科器械,其中所述选择器开关包括选择器杆,所述选择器杆被可运动地支撑在所述推块内并能够在所述启用位置和所述禁用位置之间选择性地运动,在所述启用位置中,所述推块联接至所述刀杆,在所述禁用位置中,所述推块能够相对于所述刀杆选择性地运动。
4.根据权利要求3所述的外科器械,其中所述至少一个推杆附接至所述推块,并且其中所述刀杆被可滑动地容纳在所述推块中的纵向槽内,并且其中所述选择器杆能够沿基本上横向于所述纵向槽的轴线在所述启用位置和所述禁用位置之间选择性地运动。
5.根据权利要求1所述的外科器械,其中所述刀杆在其远端上具有刀片。
6.根据权利要求5所述的外科器械,其中所述刀片能够从所述刀杆的所述远端拆卸。
7.根据权利要求1所述的外科器械,包括刀片,所述刀片被可操作地支撑在所述钉仓中并且能够接收来自所述刀杆的切割运动。
8.根据权利要求7所述的外科器械,其中所述刀杆的所述远端能够邻接所述钉仓中的所述刀片并且在对所述刀杆施加所述启动运动时使所述刀片在所述钉仓内朝远侧前进。
9.一种用于处理外科器械的方法,包括:
获得根据权利要求1所述的外科器械;
对所述外科器械进行消毒;以及
将所述外科器械存储在无菌容器中。
10.一种外科缝合器械,包括:
第一钳口构件,所述第一钳口构件能够可操作地支撑钉仓,所述钉仓中存储有多个缝钉,其中所述第一钳口构件和所述钉仓中的至少一者能够可滑动地支撑缝钉驱动器,所述缝钉驱动器能够从所述钉仓部署所述缝钉;
第二钳口构件,所述第二钳口构件能够可拆卸地联接至所述第一钳口构件,以用于将组织选择性地夹紧在所述第一钳口构件和所述第二钳口构件之间,所述第二钳口构件具有砧部,所述砧部能够在从所述钉仓部署所述缝钉时使所述缝钉变形;
至少一个推杆,所述至少一个推杆能够使所述缝钉驱动器相对于所述第一钳口构件和所述第二钳口构件运动;
致动器旋钮,所述致动器旋钮从所述至少一个推杆延伸并且能够朝所述第一钳口构件和所述第二钳口构件的远端运动;
刀杆,所述刀杆相对于所述致动器旋钮被可操作地支撑;以及
选择器装置,所述选择器装置与所述致动器旋钮和所述刀杆交接以用于使所述刀杆与所述致动器旋钮选择性地接合,使得当所述致动器旋钮朝所述第一钳口构件和所述第二钳口构件的所述远端运动时,所述刀杆和所述至少一个推杆朝所述第一钳口构件和所述第二钳口构件的所述远端前进,所述选择器装置还能够使所述刀杆从所述致动器旋钮选择性地脱离,使得当所述致动器旋钮朝所述第一钳口构件和所述第二钳口构件的所述远端运动时,所述至少一个推杆朝所述第一远端和所述第二远端前进而所述刀杆不与所述至少一个推杆一起前进。
11.一种用于处理外科器械的方法,包括:
获得根据权利要求10所述的外科缝合器械;
对所述外科缝合器械进行消毒;以及
将所述外科缝合器械保存在无菌容器中。
12.一种与外科缝合器械一起使用的外科钉仓,所述外科缝合器械具有端部执行器,所述端部执行器具有第一钳口构件和第二钳口构件以用于将组织夹紧在所述第一钳口构件和第二钳口构件之间,所述外科缝合器械还具有用于产生切割运动的刀杆组件和用于产生缝钉击发运动的推杆装置,所述缝钉击发运动独立于所述切割运动,所述钉仓包括:
仓主体,所述仓主体能够被可拆卸地支撑在所述端部执行器中,所述仓主体可操作地支撑多个缝钉,所述多个缝钉被定向成多个纵向延伸的排并能够在对所述缝钉施加所述缝钉击发运动时从所述仓主体中被顶出;以及
切割刀片,所述切割刀片被可操作地支撑在所述仓主体中并能够在对所述切割刀片施加所述切割运动时选择性地从位于所述仓主体的第一端部处的未致动位置运动至位于所述仓主体的第二端部处的致动位置,所述切割刀片能够在对所有的所述缝钉施加所述击发运动期间保持在所述未致动位置并在对所述切割刀片施加所述切割运动时从所述未致动位置运动至所述致动位置。
13.根据权利要求12所述的外科钉仓,其中所述切割刀片能够在对所述切割刀片施加回缩运动时从所述致动位置运动至所述未致动位置。
14.根据权利要求13所述的外科钉仓,其中所述切割刀片上具有钩状形成物,以用于当所述仓主体被可操作地支撑在所述第一钳口构件中时可拆卸地接合所述外科缝合器械的刀杆的一部分。
15.根据权利要求12所述的外科钉仓,其中所述切割刀片能够当所述仓主体被可操作地支撑在所述第一钳口构件中时与所述外科缝合器械中的刀杆的端部邻接。
16.根据权利要求12所述的外科钉仓,还包括位于所述仓主体上的覆盖物,以用于当所述切割刀片处于所述未致动位置时基本上覆盖所述切割刀片的突出到所述仓主体之外的部分。
17.根据权利要求12所述的外科钉仓,还包括位于所述仓主体中的纵向槽,并且其中所述纵向延伸的缝钉排在所述纵向槽的每一侧上包括一对间隔的纵向延伸的排,并且其中所述切割刀片能够被运动地支撑以便在所述纵向槽中纵向行进。
18.一种用于处理外科器械的方法,包括:
获得根据权利要求12所述的外科钉仓;
对所述外科钉仓进行消毒;以及
将所述外科钉仓存储在无菌容器中。
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- 2011-07-27 CN CN201180037523.8A patent/CN103037782B/zh active Active
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AU2011282705A1 (en) | 2013-02-14 |
WO2012015935A1 (en) | 2012-02-02 |
CA2806437C (en) | 2019-06-04 |
EP2598051A1 (en) | 2013-06-05 |
EP2598051B1 (en) | 2019-10-16 |
US8789740B2 (en) | 2014-07-29 |
BR112013002208B1 (pt) | 2020-12-01 |
US20120024936A1 (en) | 2012-02-02 |
AU2011282705B2 (en) | 2014-01-23 |
CA2806437A1 (en) | 2012-02-02 |
JP5795373B2 (ja) | 2015-10-14 |
JP2013533056A (ja) | 2013-08-22 |
CN103037782B (zh) | 2015-12-09 |
BR112013002208A2 (pt) | 2016-05-24 |
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