CN104546042A - 用于砧座和钉仓的吻合线加固件 - Google Patents

用于砧座和钉仓的吻合线加固件 Download PDF

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CN104546042A
CN104546042A CN201410778512.0A CN201410778512A CN104546042A CN 104546042 A CN104546042 A CN 104546042A CN 201410778512 A CN201410778512 A CN 201410778512A CN 104546042 A CN104546042 A CN 104546042A
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nail bin
anvil assembly
bin groupware
nearside
surgical
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CN104546042B (zh
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迈克尔·D·英曼松
萨钦·沙阿
约瑟夫·麦克内利
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Covidien LP
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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
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0684—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying above the tissue during stapling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder

Abstract

本公开提供了一种用于砧座和钉仓的吻合线加固件。本公开还提供了一种手术吻合装置，包括：钉仓组件，其限定第一组织接触面；砧座组件，其限定第二组织接触面；以及手术支撑件，其可释放地固定到所述第一组织接触面和所述第二组织接触面的至少一个上。所述支撑件提供一致的外形用于加载单元的所述砧座和钉仓两者。

Description

用于砧座和钉仓的吻合线加固件
本申请是申请号为201010517292.8、申请日为2010年10月15日、发明名称为“用于砧座和钉仓的吻合线加固件”的专利申请的分案申请。
技术领域
本公开涉及一种手术吻合装置，并且更特别地，涉及一种包括用于砧座和吻合钉钉仓的可拆卸的手术支撑件(buttress)的手术吻合装置。
背景技术
在本领域中已知的是用于连续或同时施加一排或多排紧固件以连接身体组织部分的手术吻合器械。典型的紧固件是手术吻合钉的形式但也可使用两件式聚合紧固件(polymeric fasteners)。这种设备一般包括一对钳夹以在其间夹住待连接的身体组织。典型地，钳夹构件中的一个包括吻合钉钉仓，所述吻合钉钉仓容纳多个被布置成至少两横排的吻合钉；而另一个钳夹构件具有砧座，所述砧座限定当吻合钉被从吻合钉钉仓推出时用于成形吻合钉腿的表面。
当吻合器械启动时，纵向平移的凸轮接触在钳夹中的一个中的吻合钉驱动构件，吻合钉驱动构件依次作用在吻合钉推动器上从而从吻合钉钉仓中连续地或同时射出吻合钉。刀片可在吻合钉排之间移动以纵向地切割和/或切开吻合钉排之间的被吻合的组织。例如，在美国专利第3,079,606号和美国专利第3,490,675号中公开了这种器械。
当吻合相对薄或较脆的组织时，有效地密封吻合线(staple line)以防止空气或流体渗漏是很重要的。另外，通常需要紧靠组织加固吻合线以防止撕裂组织或拉动吻合钉穿出组织。防止撕裂或拉穿的一种方法包括在吻合钉和其下面的组织之间放置生物相容的织物加固材料，或“支撑件”。在这种方法中，贴着组织放置一层支撑件材料并且以常规方法吻合该组织。在最近的方法中，在吻合组织之前将支撑件层定位在吻合器械本身上。一些手术吻合器利用紧固件或夹子来暂时地将支撑件材料连接到吻合器的每个钳夹上，即，一个布置在吻合钉钉仓组件上且另一个布置在砧座组件上。
本申请的期望是提供一种吻合线加固件外形(profile)，其同时合并了满足一种以上不同组件的要求的部件(feature)。而且还期望的是，提供一种能够用于手术吻合钉钉仓组件和/或手术砧座组件上的单一外形的支撑件。因此，本公开的目的是满足上述期望。
发明内容
本公开涉及一种包括手术支撑件的手术吻合装置。
根据本公开的一个方案，手术吻合装置被提供且包括：钉仓组件，其限定第一组织接触面，该钉仓组件在其中容纳多个手术紧固件，该钉仓组件限定至少一个远侧固定点(attachment point)和至少一个近侧固定点；砧座组件，其限定第二组织接触面，该砧座组件相对于钉仓组件可活动地固定，该砧座组件限定至少一个远侧固定点和至少一个近侧固定点，其中砧座组件的至少一个近侧固定点与钉仓组件的至少一个近侧固定点偏移一轴向距离；以及手术支撑件，其可释放地固定到第一组织接触面和第二组织接触面中的每一个上，手术支撑件包括主体部，该主体部构造为：基本位于第一长度的钉仓组件和砧座组件的第一和第二组织接触面中的至少一个的上面，或者基本位于第二长度的钉仓组件和砧座组件的第一和第二组织接触面中的至少一个的上面。
每个手术支撑件限定：用于与钉仓组件和砧座组件的远侧固定点相对准的远侧固定部件；以及第一近侧固定部件和与第一近侧固定部件偏移一轴向距离的第二近侧固定部件。第一近侧固定部件与钉仓组件的近侧固定点相对准；并且第二近侧固定部件与砧座组件的近侧固定点相对准。
可紧靠钉仓组件的组织接触面布置的手术支撑件和可紧靠砧座组件的组织接触面布置的手术支撑件具有基本相同的长度。
每个手术支撑件可具有相同的结构。每个手术支撑件可由生物相容的和生物可吸收的材料制成。
手术吻合装置可进一步包括缝合线(suture)，其保持手术支撑件紧靠钉仓组件和砧座组件的组织接触面。
手术吻合装置可进一步包括缝合线，其使手术支撑件的远侧端部分别紧靠钉仓组件和砧座组件中的相应一个，其中缝合线使手术支撑件的远侧固定部件保持与钉仓组件和砧座组件中的相应一个的远侧固定点相对准。
手术吻合装置可进一步包括缝合线，其保持手术支撑件的近侧端部紧靠钉仓组件和砧座组件中的相应一个，其中缝合线使手术支撑件的第一近侧固定部件与钉仓组件和砧座组件的近侧固定点保持对准，并且其中缝合线使手术支撑件的第二近侧固定部件与砧座组件的近侧固定点保持对准。
根据本公开的另一个方案，手术吻合装置被提供且包括：钉仓组件，其限定第一组织接触面，该钉仓组件在其中容纳多个手术紧固件，该钉仓组件为第一长度或者为长于第一长度的第二长度；砧座组件，其限定第二组织接触面，该砧座组件相对于钉仓组件可活动地固定，该砧座组件为各自与钉仓组件的长度相对应的第一长度或者第二长度；以及手术支撑件，其可释放地固定到第一组织接触面和第二组织接触面中的至少一个上，手术支撑件包括头部、颈部和主体部。头部通过颈部连接到主体部的远侧端上。手术支撑件被构造为：基本位于第一长度的钉仓组件和砧座组件的第一和第二组织接触面中的至少一个的上面，或者基本位于第二长度的钉仓组件和砧座组件的第一和第二组织接触面中的至少一个的上面。
手术支撑件的主体部可限定在其近侧边缘上形成的凹口，该凹口纵向地平分近侧边缘。凹口可为具有V形外形的槽口。
手术支撑件的主体部可限定至少一对相对的近侧凹口，并且至少一对相对的近侧凹口中的每一个可靠近手术支撑件的近侧边缘形成在主体部的相对的横向侧上。至少一对相对的近侧凹口可为具有V形外形的槽口。
手术支撑件的主体部可进一步限定一对相对的远侧凹口，并且该对相对的远侧凹口中的每一个可靠近主体部的远侧边缘形成在主体部的相对的横向侧上。
所述一对相对的远侧凹口可为纵向渐缩的(tapered)。手术支撑件的主体部的远侧边缘可为弓形。手术支撑件的主体部的远侧边缘具有的横向宽度尺寸可小于主体部的其余部分的横向宽度尺寸。头部可具有大致矩形形状。
每个手术支撑件可由生物相容的和生物可吸收的材料制成。
根据本公开的又一个方案，提供了一种用于手术吻合装置中的手术支撑件。该手术支撑件包括：主体部；颈部；以及头部，其通过颈部连接到主体部的远侧端上，其中主体部限定至少一对相对的近侧凹口，至少一对相对的近侧凹口中的每一个靠近主体部的近侧边缘形成在主体部的相对的横向侧上。
至少一对相对的近侧凹口中的每一个可为具有v形外形的槽口。主体部可进一步限定一对相对的远侧凹口，所述一对相对的远侧凹口中的每一个可靠近主体部的远侧边缘形成在主体部的相对的横向侧上。
手术支撑件的主体部可进一步限定形成在其近侧边缘上的近侧边缘凹口，该近侧边缘凹口纵向地平分近侧边缘。手术支撑件的主体部的远侧边缘可为弓形的。手术支撑件的主体部的远侧边缘具有的横向宽度尺寸可小于主体部的其余部分的横向宽度尺寸。头部可具有大致矩形形状。
手术支撑件可由生物相容的和生物可吸收的材料制成。
根据本公开的再一个方案，提供了一种用于与手术吻合装置一起使用的手术支撑件，其具有任意长度值的钉仓组件和与钉仓组件的长度相对应的任意长度值的砧座组件，其中钉仓组件和砧座组件中的每一个限定相应并置的组织接触面，并且其中钉仓组件包括存储在其吻合钉槽中的多个吻合钉以抵住砧座组件的吻合钉成形坑而形成。手术支撑件包括主体部，该主体部被构造且被定尺寸为位于钉仓组件的所有吻合钉槽的上方以用于任何长度的钉仓组件，和/或位于砧座组件的所有吻合钉成形坑的上方以用于任何长度的砧座组件。手术支撑件进一步包括：从主体部延伸出的颈部；以及连接到颈部上且与主体部的远侧端相对的头部，其中主体部限定至少一对相对的近侧凹口，至少一对相对的近侧凹口中的每一个靠近主体部的近侧边缘形成在主体部的相对的横向侧上。
附图说明
将结合附图对本公开进行进一步的描述，其中在若干图中的相同的附图标记表示相同的部件，并且其中：
图1为根据本公开的实施例的手术吻合装置的立体图；
图2为图1的手术吻合装置的DLU的远侧端的顶视分解立体图；
图3为根据本公开的实施例的支撑件的顶视平面图；
图4为图2的DLU的钉仓半部(half-section)的顶视立体图；
图5为图2的DLU的钉仓组件的立体图；
图6为图5的钉仓组件的远侧端的放大立体图；
图7为图5的被标示部分的细节的放大图；
图8为图7的被标示部分的细节的放大图；
图9为图2的DLU的砧座组件的立体图，其示出了被固定到其上的图3的支撑件；以及
图10为图4-8的DLU的钉仓组件和图9的DLU的砧座组件的平面图，其示出了图3的支撑件在相应的钉仓组件和砧座组件的不同的固定点处的固定。
具体实施方式
现在将结合附图详细描述本公开的用于手术吻合装置的加载单元的砧座和钉仓的吻合线加固件的实施例，其中在各个图中相同的附图标记表示相同或相应的元件。在附图和下面的描述中，根据惯例术语“近侧”将指吻合装置的最接近于操作者的端部，而术语“远侧”将指该装置的离操作者最远的端部。
现在参考图1，公开了一种一般以10指代的线性手术吻合装置。为了简洁，本公开将主要地关注用于诸如单次使用加载单元(“SULU”)或可置换加载单元(“DLU”)的加载单元100中的支撑件上。为了简便，在下文中，SULU或DLU将称作“DLU”，但应当理解的是，其包括DLU或SULU中的任一种或者包括DLU和SULU两者。在美国专利第7,128,253号中公开了这种类型的手术吻合器械的示例性实例，其全部公开内容通过引用被合并于此。
手术吻合装置10主要包括手柄组件12和从手柄组件12向远侧延伸的细长体14。DLU100以可释放的方式固定到细长体14的远侧端上。DLU100包括容纳多个手术紧固件或吻合钉223(见图2)的钉仓组件200和相对于钉仓组件200可活动地固定的砧座组件300。手柄组件12包括固定手柄构件22、可动手柄构件24以及筒形部(barrel portion)26。铰接杆30邻近可旋转构件28安装在筒形部26的前端上以便于DLU100的铰接。一对旋钮32沿着筒形部26可活动地定位。旋钮32向远侧推进以使钉仓组件200和/或砧座组件300接近或闭合，并且向近侧拉回以使钉仓组件200和/或砧座组件300相分离或打开。可动手柄构件24的致动将多列的吻合钉223施加于组织上。为了使钉仓组件200和砧座组件300相对于待吻合组织适当地定向，手术吻合装置10另外在筒形部26的前端上设置有可旋转构件28。可旋转构件28相对于手柄组件12的转动使细长体14和加载单元100相对于手柄组件12转动从而使钉仓组件200和砧座组件300相对于待吻合组织定向。
如图2所示，钉仓组件200包括限定细长支撑槽212的托架210。托架210的细长支撑槽212被定尺寸且构造为选择性地在其中容纳吻合钉钉仓220。吻合钉钉仓220包括在其中形成的保持槽222以容纳多个紧固件223和推动器226。多个间隔开的纵向槽延伸通过吻合钉钉仓220以容纳致动滑块(actuation sled)228的直立凸轮楔块。中央的纵向槽234形成在吻合钉钉仓220中并且沿着吻合钉钉仓220的长度延伸以便于驱动杆150的刀片156穿过其中。在手术吻合器10的工作期间，致动滑块228平移通过吻合钉钉仓220以推进凸轮楔块与推动器226顺序接触，从而使推动器226垂直地在保持槽222内平移且推动吻合钉223从槽222进入砧座组件300的砧座板310的吻合钉成形室。
如图2所示，钉仓组件200包括手术钉仓支撑件500，所述手术钉仓支撑件500可操作地通过缝合线“S1、S2”固定到吻合钉钉仓220的上表面从而覆盖在至少一些保持槽222的上面和/或覆盖在纵向槽234的长度的至少一部分的上面。第一缝合线“S1”穿过远侧的一对凹口或固定点238中的每一个且绕过/越过钉仓支撑件500的远侧部，并且第二缝合线“S2”穿过近侧的一对凹口或固定点236中的每一个且绕过/越过钉仓支撑件500的近侧部。每条缝合线“S1、S2”的第一端可锚定或固定到近侧的一对凹口或固定点236和远侧的一对凹口或固定点238的相应的一个凹口中，而每条缝合线“S1、S2”的第二端横向跨过钉仓支撑件500的相应的远侧部和近侧部并且锚定或固定到近侧的一对凹口或固定点236和远侧的一对凹口或固定点238中的相应的另一个凹口中。如图10所示，钉仓组件200在远侧的一对凹口或固定点238和近侧的一对凹口或固定点236之间限定轴向距离“D1”。
仍然参考图2，砧座组件300包括具有多个吻合钉变形坑/室310a的砧座板310(见图9)和固定到砧座板310的顶面上的盖板320。砧座组件300进一步包括刀片330，所述刀片330可操作地插入砧座板310和盖板320之间限定的室内。
砧座板310限定近侧的一对凹口或固定点316，所述一对凹口或固定点316靠近砧座板310的近侧端形成并且在纵向槽314的相对侧上每侧各布置一个凹口或固定点。砧座板310限定远侧的一对凹口或固定点318，所述一对凹口或固定点318靠近砧座板310的远侧端形成并且在纵向槽314的相对侧上每侧各布置一个凹口或固定点。近侧的一对凹口或固定点316和远侧的一对凹口或固定点318的每对中的至少一个凹口为具有狭窄的外形的狭槽或槽口的形式，从而摩擦地接合并/或夹紧(pinch)缝合线“S”。砧座组件300进一步包括手术砧座支撑件500，所述手术砧座支撑件500可操作地通过缝合线“S3、S4”固定到砧座板310的底面上，从而覆盖在至少一些砧座坑310a的上面和/或覆盖在纵向槽314的长度的至少一部分的上面。
仍参考图2，砧座支撑件500通过锚定件(anchor)“S3、S4”固定到砧座板310的底面上，从而覆盖在至少一些砧座坑的上面和/或覆盖在纵向槽314的长度的至少一部分的上面。特别地，锚定件“S3”穿过砧座支撑件500的远侧部和对应的远侧的一对凹口或固定点318中的每一个，并且锚定件“S4”穿过砧座支撑件500的近侧部和对应的近侧的一对凹口或固定点316中的每一个。如图10所示，砧座组件300在远侧的一对凹口或固定点318和近侧的一对凹口或固定点316之间限定轴向距离“D2”。
为详细地论述手术吻合装置10、钉仓组件200和/或砧座组件300的结构和操作，可参考2008年12月23日提交的序列号为12/342,400的美国专利申请，其全部内容通过引用合并于此。
用于钉仓组件200和砧座组件300中的每一个的支撑件500被设置为加固且密封通过手术吻合装置10施加于组织的吻合线。当手术吻合装置10被插入患者的身体内并且在患者的身体内操作时，为了便于手术吻合装置10进入患者的身体而各个支撑件没有裂开或起皱的风险，钉仓组件200和砧座组件300被特别地构造为允许手术支撑件500被定位在钉仓组件200和砧座组件300的向内的表面上。形成支撑件500的材料可为生物可吸收的或生物不可吸收的。应当理解的是，自然的、合成的、生物可吸收的以及生物不可吸收的材料的任意组合可用来形成支撑件材料。支撑件材料可为多孔或无孔的、多孔层和无孔层的组合。无孔支撑件材料可被用来阻碍或防止组织从周边组织向内生长从而起到粘连屏障的作用并且防止形成不想要的疤痕组织。
为与这里公开的手术吻合器械一起使用，在共同转让的美国专利申请第5，542，594；5，908，427；5，964，774和6，045，560号中以及在共同转让的美国申请公开第2006/0085034号(于2006年4月20日提交)和2006/0135992号(于2006年6月22日提交)中陈述了用于手术支撑件500的另外的示例性材料，上述每个专利的全部内容通过引用合并于此。
在实施例中，手术支撑件500可由适合的生物相容的和生物可吸收的材料制成。手术支撑件500也可由不保留流体的非吸收性的材料制成，例如，手术支撑件500可由“BIOSYNTM”(一种合成聚酯，商业上可从Tyco医疗健康集团，LP d/b/a COVIDIEN，North Haven，CT获得)制成，“BIOSYNTM”由“GLYCOMER 631”(一种嵌段共聚物)制成，而“GLYCOMER 631”是由乙交酯、二氧环己酮(dioxanone)和三亚甲基碳酸酯(trimethylene carbonate)组成是合成聚酯。
合成的共聚物的一嵌段包含衍生自聚对二氧环己酮(1,4-二恶烷-2-酮)和三亚甲基碳酸酯(1,3-二恶烷-2-酮)的随机结合的单位。共聚物的第二嵌段包含衍生自乙交酯和聚对二氧环己酮的随机结合的单位。合成的聚酯为具有大约60％的乙交酯、大约14％的二氧环己酮和大约26％的三亚甲基碳酸酯的ABA型三嵌段的三元共聚物。
砧座支撑件和/或钉仓支撑件500可预加载(即由制造者预加载)到砧座组件300或钉仓组件200上。用于砧座组件300和/或钉仓组件200的另外的或置换支撑件500可根据需要或期望固定到砧座组件300或者钉仓组件200上。
在手术时，通过使DLU100联接到手术吻合装置10的细长体14的远侧端，并且通过使砧座支撑件和钉仓支撑件500分别预加载到砧座组件300和钉仓组件200上，手术吻合装置10按照本领域技术人员已知的方法使用。一旦砧座组件300和钉仓组件200夹在组织上，手术吻合装置10就启动。在启动手术吻合装置10时，驱动杆150从DLU100的最近侧的位置推进到最远侧的位置。在这种情况下，驱动杆150的刀片156进入支撑件500的槽口528从而便于支撑件500的分割并且减少因刀片156引起的支撑件500的任何推动或聚团的发生。当驱动杆150开始向远侧移动时，刀片156基本上同时割开砧座组件300和钉仓组件200的近侧锚定件“S2、S4”的中央部分，从而从此处分别释放砧座支撑件和钉仓支撑件500的近侧端。当刀片156向远侧运动时，刀片156沿纵向切穿或割穿砧座支撑件500和钉仓支撑件500两者，从而使支撑件500基本上分割成两半。
另外地，当驱动杆150接近最远侧的位置时，驱动杆150和/或刀片156接合缝合线切割组件或缝合线释放组件，如在全部内容通过引用合并于此的于2008年12月23日提交的序列号为12/342,400的美国专利申请中所描述的，从而切断或释放远侧缝合线“S1或S3”并且因而释放支撑件500的远侧端。
参考图3，示出根据本公开的具有一致外形的手术支撑件500的实施例。支撑件500包括头部510、主体部520以及使头部510和主体部520相互连接的颈部530。
支撑件500构造为可拆卸地固定到如上所述的任意尺寸的砧座组件300和/或钉仓组件200上。支撑件500的主体部520在靠近其远侧位置522的横向边缘上限定一对相对的远侧凹口524。这对相对的远侧凹口524可被用来通过使用缝合线“S1或S3”中的任一个或者通过诸如吻合钉的任何其他类型的紧固件来将主体部520固定到砧座组件300和/或钉仓组件200的远侧端上。主体部520的远侧部522具有诸如成角度的、弓形的减小的横截面尺寸，从而适合于具有不同形状的各种类型的砧座和钉仓组件。
支撑件500的主体部520进一步限定靠近主体部520的近侧端形成的两对相对的近侧凹口526a、526b。所述两对近侧凹口526a、526b中的每一对布置在主体部520靠近其近侧边缘的横向侧上。所述近侧凹口526a、526b用来可拆卸地将支撑件500固定到砧座组件300和/或钉仓组件200的近侧端上。为适应各类外形，支撑件500的主体部520优选地设置有两对相对的凹口，第一近侧对526a和第二近侧对526b(位于第一近侧对526a的远侧)。所述近侧凹口对526a、526b中的每对具有基本v形外形，尽管可以考虑其他的形状。
特别地，当支撑件500与相对较长的砧座组件300和/或钉仓组件200一起使用时，那么缝合线“S2或S4”延伸跨过支撑件500的主体部520的近侧端，经过支撑件500的最近侧凹口对526a，并且被分别固定到砧座组件300的凹口316上和/或钉仓组件200的凹口236上。而且，当支撑件500与相对较短的砧座组件300和/或钉仓组件200一起使用时，那么缝合线“S2或S4”延伸跨过支撑件500的主体部520的近侧端，经过支撑件500的所述近侧凹口对的远侧对526b，并且被固定到相应的砧座组件300的凹口316上和/或钉仓组件200的凹口236上。
根据本公开的另一个方案，单一外形或构造的支撑件500可与钉仓组件200和/或砧座组件300结合使用。例如，与钉仓组件200和砧座组件300结合使用的支撑件500可各自具有相同的总长、宽度、厚度、圆周外形以及结构材料。
特别地，如图10所示，当支撑件500与钉仓组件200结合使用时，缝合线“S1”可横向延伸跨过钉仓组件200的远侧端部且被钉仓组件200的远侧的一对凹口或固定点238捕获(captured)或被固定到钉仓组件200的远侧的一对凹口或固定点238上，其中缝合线“S1”与支撑件500的牢固的(secure)主体部520的远侧凹口524相对准。另外地，当支撑件500与钉仓组件200结合使用时，缝合线“S2”可横向延伸跨过钉仓组件200的近侧端部且被钉仓组件200的近侧的一对凹口或固定点236的每个捕获或被固定到钉仓组件200的近侧的一对凹口或固定点236的每个上，其中缝合线“S2”与支撑件500的主体部520的近侧凹口对的最近侧对526a相对准。
继续参考图10，当支撑件500与砧座组件300结合使用时，缝合线“S3”可横向延伸跨过砧座组件300的远侧端部且被砧座组件300的远侧的一对凹口或固定点318捕获或被固定到砧座组件300的远侧的一对凹口或固定点318上，其中缝合线“S3”与支撑件500的牢固的主体部520的远侧凹口524相对准。另外地，当支撑件500与砧座组件300结合使用时，缝合线“S4”可横向延伸跨过砧座组件300的近侧端部且被砧座组件300的近侧的一对凹口或固定点316的每个捕获或被固定到砧座组件300的近侧的一对凹口或固定点316的每个上，其中缝合线“S4”与支撑件500的主体部520的近侧凹口对的远侧对526b相对准。
颈部530将头部510连接到主体部520的远侧端上。一般地，头部510为基本的矩形形状，其被用作耳片(tab)以便于将支撑件500放置在砧座组件300和/或钉仓组件200的适当的位置上。在将支撑件500放置在砧座组件300和/或钉仓组件200上后，可从主体部520上撕下或割下头部510和颈部530。在特定实施例中，为此目的颈部可具有穿孔。
主体部520在其近侧边缘进一步包括槽口528。槽口528相对于纵轴线大致居中。具有三角形或V形构造(尽管可以考虑其他形状)的槽口528可用来在切割手术钉仓支撑件500期间为刀片提供引入部分。
可同时满足对一种以上不同组件的需要的支撑件500的一致外形提供了以下优点：使组装过程简单化；使独特元件的总数最小化；并且减少了与其有关的组装成本。
而且，支撑件500可用在钉仓组件200和/或砧座组件300上或与钉仓组件200和/或砧座组件300结合使用。在这种方式中，单一外形的支撑件500被生产并且被用于钉仓组件200和/或砧座组件300。这样，可减少用于支撑件500的制造和存储成本。
如上所述，DLU100包括预加载在砧座组件300和钉仓组件200上的砧座手术支撑件500和钉仓手术支撑件500。现在将描述把支撑件500加载在砧座组件300和/或钉仓组件200上的示例性方法。
在DLU100的制造和/或组装过程中，把支撑件500加载到砧座组件300和/或钉仓组件200包括将支撑件500放置在砧座组件300和/或钉仓组件200的组织接触面的上面，使得支撑件的槽口528靠近砧座组件300和/或钉仓组件200的近侧端布置且支撑件500的头部510从砧座组件300和/或钉仓组件200的远侧端延伸出。在支撑件500如此紧靠砧座组件300和/或钉仓组件200布置时，近侧缝合线“S2”和/或“S4”被拉下。通过继续拉头部510，拉力沿远侧方向被施加于支撑件500上。然后远侧缝合线“S1”和/或“S3”被拉下。此时，所有缝合线“S1-S4”被系紧在砧座组件300和/或钉仓组件200的各自的固定点316、318、236、238上。在系紧缝合线“S1-S4”以后，支撑件500的头部510可释放。接下来，DLU100可从嵌套(nesting)中去除并且支撑件500的头部510和颈部530可从主体部520上去除或切断。
本公开也考虑了一种形成支撑件的方法。支撑件由适合的生物相容的或生物相容且生物可吸收的材料形成。在特定的优选实施例中，每个支撑件由不保留流体的非吸收性材料制成。在特定实施例中，每个支撑件由“BIOSYN”制成，“BIOSYN”由GLYCOMER 631(一种嵌段共聚物)制备，该GLYCOMER631是一种由乙交酯、二氧环己酮和三亚甲基碳酸酯组成的合成聚酯。
合成共聚物的一嵌段包含衍生自聚对二氧环己酮(1,4-二恶烷-2-酮)和三亚甲基碳酸酯(1,3-二恶烷-2-酮)的随机结合的单位。共聚物的第二嵌段包含衍生自乙交酯和聚对二氧环己酮的随机结合的单位。合成的聚酯为具有大约60％的乙交酯、大约14％的二氧环己酮和大约26％的三亚甲基碳酸酯的ABA型三嵌段的三元共聚物。
在共同转让的美国专利第5,542,594；5,908,427；5,964,774和6,045,560号中以及在共同转让的序列号为第2006/0085034(于2006年4月20日提交)和2006/0135992(于2006年6月22日提交)的美国申请中示出且描述了用于与这里公开的手术吻合器械一起使用的示例性手术支撑件“B”，上述每个专利的全部内容通过引用合并于此。
支撑件的形状可通过形成一片生物相容的材料并将该片切割成期望的形状而形成。支撑件也可模制成期望的形状。在特定实施例中，一片生物相容的材料被形成然后使用辊模组(roller die sets)将外形或形状切离该片。一种形成支撑件的方法可遵循这些步骤：一片支撑件材料通过机床的一侧被进给；机床在其上具有带有准确的期望的外形的辊模组；模组在这片支撑件材料上模压准确的外形；外形仍松松地连接在该片支撑件材料上使得该片支撑件材料由第二侧从机床出来。然后将具有期望外形的支撑件从该片支撑件材料上撕下，这可以人工完成。
虽然合并使用可活动刀片以从砧座组件和钉仓组件的组织接触面切断或释放手术支撑件的上述实施例的手术吻合器已经被示出并被描述为与内窥镜手术吻合器有关，但能够想象到且在本公开的范围内任何一个上述实施例可并入任何类型的手术吻合器，包括且不限于诸如线性手术吻合器和横向手术吻合器的开放式手术吻合器。
而且，虽然只有远侧和近侧吻合线被示出且被描述为将支撑件500固定到砧座组件300和/或钉仓组件200上，但能够考虑到的是，可沿着砧座组件和/或钉仓组件的长度设置任意数目的横向缝合线以帮助沿着其长度固定支撑件500。
应当理解的是，可对这里公开的实施例进行各种改进。例如，吻合装置不需要施加吻合钉而是可施加如在本领域中已知的两件式紧固件。而且，吻合钉或紧固件的线性排的长度可改进成满足特殊的手术过程的要求。因而，可相应地改变致动轴的单行程的长度和/或可置换加载单元内的吻合钉和/或紧固件的线性排的长度。因此，以上的描述不应当被解释为限制，而仅仅是优选实施例的示例。本领域中的技术人员在附随的权利要求的范围和精神内将会想象到其他的变型。

Claims (7)

1.一种手术吻合装置，包括：
钉仓组件，其限定第一组织接触面，所述钉仓组件在其中容纳多个手术紧固件，所述钉仓组件限定至少一个远侧固定点和至少一个近侧固定点；
砧座组件，其限定第二组织接触面，所述砧座组件相对于钉仓组件可活动地固定，所述砧座组件限定至少一个远侧固定点和至少一个近侧固定点，其中所述砧座组件的所述至少一个近侧固定点与所述钉仓组件的所述至少一个近侧固定点偏移一轴向距离；以及
手术支撑件，其可释放地固定到所述第一组织接触面和所述第二组织接触面的每一个上，缝合线保持手术支撑件紧靠所述钉仓组件和所述砧座组件的组织接触面，所述手术支撑件包括主体部，所述主体部构造为：基本位于第一长度的钉仓组件和砧座组件的第一和第二组织接触面中的至少一个的上面，或者基本位于第二长度的钉仓组件和砧座组件的第一和第二组织接触面中的至少一个的上面；
每个手术支撑件限定远侧固定部件、第一近侧固定部件以及与所述第一近侧固定部件偏移一轴向距离的第二近侧固定部件。
2.根据权利要求1所述的手术吻合装置，其中紧靠所述钉仓组件的组织接触面布置的手术支撑件和紧靠所述砧座组件的组织接触面布置的手术支撑件具有基本相同的长度。
3.根据权利要求1所述的手术吻合装置，其中每个手术支撑件具有相同的结构。
4.根据权利要求1所述的手术吻合装置，其中每个手术支撑件由生物相容的和生物可吸收的材料制成。
5.根据权利要求1所述的手术吻合装置，每个手术支撑件由制造者预加载。
6.根据权利要求1所述的手术吻合装置，进一步包括缝合线，所述缝合线保持所述手术支撑件的远侧端部紧靠所述钉仓组件和所述砧座组件中相应的一个，其中所述缝合线使所述手术支撑件的所述远侧固定部件保持与所述钉仓组件和所述砧座组件中的相应一个的所述远侧固定点相对准。
7.根据权利要求1所述的手术吻合装置，进一步包括缝合线，所述缝合线保持所述手术支撑件的近侧端部紧靠所述钉仓组件和所述砧座组件中相应的一个，其中缝合线使所述手术支撑件的所述第一近侧固定部件与所述钉仓组件和所述砧座组件的所述近侧固定点保持对准，并且其中缝合线使所述手术支撑件的所述第二近侧固定部件与所述砧座组件的所述近侧固定点保持对准。
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