CN1915180A - 包括具有多种缝钉尺寸的钉仓的外科吻合器 - Google Patents

包括具有多种缝钉尺寸的钉仓的外科吻合器 Download PDF

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CN1915180A
CN1915180A CNA2006101388700A CN200610138870A CN1915180A CN 1915180 A CN1915180 A CN 1915180A CN A2006101388700 A CNA2006101388700 A CN A2006101388700A CN 200610138870 A CN200610138870 A CN 200610138870A CN 1915180 A CN1915180 A CN 1915180A
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tissue contacting
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霍尔斯滕·享利·E
薇奥拉·弗兰克·J
埃蒙斯·克利福德·L
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    • 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
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    • 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
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    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
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    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A61B17/1155—Circular staplers comprising a plurality of staples
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Abstract

一种外科吻合器，包括钉仓和砧部件。所述钉仓包括布置在多排保持槽中的多个手术扣钉。该钉仓可具有环形或者线型构造的保持槽。该钉仓的组织接触表面可以是锥形或者阶梯状。该砧部件具有包括多个安排成基本与保持槽对齐的凹口的组织接触表面。另外，砧部件的组织接触表面可与钉仓的组织接触表面互补。

Description

包括具有多种缝钉尺寸的钉仓的外科吻合器
技术领域
本公开涉及外科吻合器，尤其涉及包括具有多种缝钉尺寸的钉仓的外科吻合器。
背景技术
有一些专门适用于诸如首尾相接吻合、胃肠吻合、内窥镜胃肠吻合和横向吻合的各种操作的已知类型的外科吻合器。用于这些各个操作的缝合器的例子可在美国专利Nos.5,915,616；6,202,914；5,865,361；和5,964,394中找到。
每个外科吻合器包括一个相对于钉仓接近设置的砧。钉仓典型地具有一个或多个侧向间隔的钉排，依据特定的缝合器，可将该钉排布置成线型或非线型构造。该砧包括与钉仓内缝钉的钉槽对准和/或重合的缝钉成形凹陷。使用中，每个外科吻合器涉及夹紧待固定组织、弹射单个缝钉、使缝钉贯穿夹紧组织的施加压力以及相对于砧的缝钉成形凹陷闭合和/或形成缝钉。
应用上面所公开的任何一种外科吻合器，横断组织中和/或吻合操作中的共有问题是吻合强度和止血完成程度间的平衡。众所周知在砧和钉仓之间具有固定间隙(即一致的距离)的外科吻合器中包括不同尺寸的缝钉。
发明内容
本公开涉及配置成在组织界面上实现吻合强度和止血程度间改善平衡的外科吻合器。尤其是，本公开的实施例包括不同尺寸的手术扣钉。更进一步，砧部件和钉仓之间的距离(即间隙)从钉仓的中心线向钉仓的外边缘发生变化。将不同尺寸的手术扣钉与砧部件和钉仓之间变化的间隙结合起来在组织界面处提高了吻合强度和止血程度。
根据本公开的一个方面，外科吻合器包括界定了具有可操作地与其联接的砧部件的第一结构，以及界定了可操作地与其联接的钉仓的第二结构。钉仓包括具有阶梯状剖面轮廓的组织接触表面。钉仓的组织接触表面还包括多个形成于其中以保持手术扣钉的保持槽。在外科吻合器的使用期间，砧部件和钉仓相对于彼此接近。
钉仓的阶梯状接触表面界定了多个组织接触表面，其每一个具有不同的高度。在一个实施例中，钉仓的阶梯状组织接触表面包括具有一高度的内组织接触表面、具有高度比内组织接触表面高度低的中间组织接触表面以及具有高度比中间组织的接触表面高度低的外组织接触表面。
内、中和外组织接触表面每个包括至少一排形成于其中的保持槽。将多个手术扣钉一一地布置在每个保持槽中。每个手术扣钉包括一个背跨(backspan)和一对向下的支脚。
保持在内组织接触表面中所形成的保持槽内的手术扣钉具有第一脚长度，保持在中间组织接触表面中所形成的保持槽内的手术扣钉具有第二脚长度，以及保持在外组织接触表面中所形成的保持槽内的手术扣钉具有第三脚长度。在一个实施例中，保持在内组织接触表面中所形成的保持槽内的手术扣钉具有大约2.3mm的脚长度，而保持在中间组织接触表面中所形成的保持槽内的手术扣钉具有大约3.5mm的脚长度，以及保持在外组织接触表面中所形成的保持槽内的手术扣钉具有大约4.1mm的脚长度。
可以想到外科吻合器可以是圆形外科吻合器，其中砧部件和钉仓可以是环形的。在一个实施例中，多个组织接触表面在径向朝外的方向上高度降低。因此，内组织接触表面最接近中心而外组织接触表面离环形钉仓的中心最远。而且，具有相对较矩脚长度的手术扣钉保持在离环形钉仓的中心最近的保持槽中，而具有相对较长脚长度的手术扣钉保持在离环形钉仓的中心最远的保持槽中。
进一步可以想到外科吻合器可以是线型外科吻合器，其中砧部件和钉仓是线型的。在这些器械中，钉仓和/或砧部件能界定一刀割线。因此，  多个组织接触表面在刀割线垂直朝外的方向上高度降低。特别地，内组织接触表面最接近刀割线而外组织接触表面离刀割线最远。另外，具有相对较短脚长度的手术扣钉保持在离刀割线最近的保持槽中，而具有相对较长脚长度的手术扣钉保持在离刀割线最远的保持槽中。
可以想到砧部件可具有包括多个组织接触表面呈阶梯状剖面轮廓的组织接触表面，其中每个组织接触表面具有不同的高度。另外，多个组织接触表面的每一个可包括至少一个形成于其中的环形和/或线型排手术扣钉成形凹陷。
在一个实施例中，砧部件可具有与钉仓的阶梯状组织接触表面形状互补(即阶梯状的)的组织接触表面。在另一个实施例中，砧部件可具有阶梯状的组织接触表面而钉仓的组织接触表面基本上是平坦的。在又一实施例中，砧部件可具有与钉仓的阶梯状组织接触表面形状基本互补的组织接触表面(即砧部件的阶梯状组织接触表面的深度不等于钉仓组织接触表面的单个组织接触表面的高度)。在再一实施例中，砧部件可具有与钉仓的组织接触表面成镜像对称的阶梯状组织接触表面(即砧部件组织接触表面的单个组织接触表面的深度基本上等于钉仓单个组织接触表面的深度)。
在本公开的其他实施例中，外科吻合器包括在其一端布置的操作工具。该操作工具包括砧部件和钉仓。可将钉仓包括在一次性手术缝合装置或者重复使用的手术缝合装置中。更进一步，可在一次性或者再次使用的手术缝合装置中设置可替换的加载单元。在一个实施例中，可替换的加载单元包括钉仓，而可替换的加载单元的可选实施例包括钉仓和砧部件。特别地，钉仓包括多个布置在多排保持槽中的手术扣钉。该手术扣钉可具有不同的脚长度，其中将具有基本上相同腿长的多个手术扣钉布置在一排中。将许多扣钉弹射部件布置在钉仓内，其中每个扣钉弹射部件包括多个缝钉推动器以便与致动机构协同弹射手术扣钉。
钉仓可包括以钉仓的中心线为顶点并朝着钉仓的外壁成锥形的成角度的组织接触表面。可选的，钉仓的组织接触表面可具有一表面平行于钉仓底部表面或者平行于由布置在所选排中的手术扣钉的背跨所界定的表面。组织接触表面的平行表面具有足够容纳至少一排手术扣钉的宽度尺寸。该钉仓可包括刀具路径。
与当前公开的钉仓协作，砧部件可包括基本平行于钉仓底部表面或者基本平行于由布置在所选排中的手术扣钉的背跨所界定的表面的平坦的组织接触表面。在备选方案中，砧部件的组织接触表面是以与钉仓的组织接触表面的角相反的方式成角度的。更进一步，砧部件的组织接触表面可具有基本平行于钉仓的底部表面或者基本平行于由布置在所选排中的手术扣钉的背跨所界定的表面的平面以及界定了与钉仓的组织接触表面所界定的角度呈相反角度的锥形表面。砧部件的平行表面具有的宽度尺寸对应于钉仓的平行表面的宽度尺寸。
进一步可以设想的是手术缝合装置的一个实施例包括用于组织固定层补充密封的结构。在一个实施例中，手术缝合装置包括具有储腔和供应管线的伤口闭合组件。该储腔适合存储一些伤口闭合物质并经过供应管线流体地连通到钉仓以用来将一定量的伤口闭合物质传送到多个保持槽中。
通过附图的描述和实施例的详细描述将在下面进行更清晰地阐述本公开的外科吻合器，以及伴随的优点。
通过考虑结合附图的以下描述，本公开的其他目的和特征将变得很明显。
附图说明
参考附图在此描述本公开的手术缝合装置的实施例，其中：
图1是根据本公开所构造的外科吻合器的立体图；
图2是从图1的2-2向看去，图1的外科吻合器远端部分的示意性剖面侧面正视图；
图3A是图2的指示区域的放大示图，阐明了根据本公开的可选实施例的组织接触表面；
图3B是图2的指示区域的放大示图，阐明了根据本公开的另一实施例的组织接触表面；
图3C是图2的指示区域的放大示图，阐明了根据本公开的又一实施例的组织接触表面；
图3D是图2的指示区域的放大示图，阐明了根据本公开的再一实施例的组织接触表面；
图4是根据本公开所构造的可选外科吻合器的立体图；
图5是根据本公开所构造的又一外科吻合器的立体图；
图6是根据本公开所构造的再一外科吻合器的立体图；
图6A是图6的砧部件的一部分的立体图；
图7是从图4-6每一个的7-7向看去，图4-6的外科吻合器远端部分的示意性剖面侧面正视图；
图7A是图6的外科吻合器远端部分的备选实施例的示意性剖面侧面正视图；
图8是图7的外科吻合器弹射之后产生的组织界面的剖面侧面正视图。
具体实施方式
现在将参照附图详细地描述本公开的外科吻合器的实施例，其中相同的附图标记表示相似或同样的元件。在附图和下面的描述中，术语“近端”按照惯例将表示最接近操作者的外科吻合器的端部，而术语“远端”将表示离操作者最远的设备的端部。
本公开涉及用于一次性或者重复使用的外科吻合器的钉仓和砧部件。本次所公开的钉仓和砧部件，如以下所详细讨论的，可与在图1、4、5或者6中所示的任何外科吻合器一起使用。另外，可将可替换的加载单元设置在一次性或者重复使用的外科吻合器中。在一个实施例中，可替换的加载单元包括一钉仓，包括在此所公开的任何一种钉仓。可选的，可替换的加载单元包括钉仓和砧部件，包括在此所公开的任何一种砧部件。与一次性或重复使用的手术缝合装置结合，可替换的加载单元提供各个外科吻合器改进的灵活性，因为各个外科吻合器容易适应不同的缝合操作。
现在详细参考图1-2，其中相同的附图标记表示相似或同样的元件，根据本公开的第一实施例，外科吻合器通常指代为100。
如图1所见，外科吻合器100包括具有至少一个枢转致动手柄部件103的手柄组件102和进一步包括推进装置105。从手柄组件102处延伸，设有管体部分104，其如比构造使得沿其长度具有弯曲形状的。管体部分104终止于具有圆形钉仓118的扣钉弹射部件组件106，该钉仓包括设置于其远端的组织接触表面121。
如图2所见，组织接触表面121是阶梯状的，包括一个外组织接触表面121a、一个中间组织接触表面121b和一个内组织接触表面121c。从缝钉推动器或者扣钉扣钉弹射部件130的底部表面131测量，每个组织接触表面121a-121c彼此具有不同的高度。特别的，组织接触表面121a-121c是彼此基本平行的平面结构，但彼此不是共面的(即阶梯状的)。另外，每个组织接触表面121a-c界定了穿过各自组织接触表面121a-c延伸的平面轴。第一壁面使组织接触表面121a和121b相互连接，同时第二壁面使组织接触表面121b和121c相互连接。第一和第二壁面是平面结构，其中每个壁面界定了一个平面轴。在一个实施例中，壁面的平面轴垂直于组织接触表面121a-c的平面轴。
内组织接触表面121c具有最高的高度，外组织接触表面121a具有最低的高度，而中间组织接触表面121b具有介于外和内组织接触表面121a、121c高度之间的高度。虽然组织接触表面121a-121c显示成从外组织接触表面121a到内组织接触表面121c(即径向向内)高度逐渐增加，但是每个组织接触表面的高度依据特定手术操作而改变也是在本公开的范围内。例如，组织接触表面121a-121c可以在径向向外的方向上高度增加，中间组织接触表面121b可以是最高或者是最低的组织接触表面，或者组织接触表面121a-121c中的至少两个具有相同的高度。
在一个实施例中，每个组织接触表面121a-121c包括形成于其中的保持槽123的各自环形排119a-119c。将环形排119a-119c的每个保持槽123构造并定制尺寸成能够在其中保持缝钉或手术扣钉扣钉125。每个手术扣钉125包括一个背跨(backspan)(未显示)和一对悬垂的支脚25。在一个实施例中，槽123的每个环形排119a-119c包括有其自有性能特征的各自的手术扣钉125a-125c。
如图2所见，手术扣钉125a的支脚25a具有第一脚长度，手术扣钉125b的支脚25b具有第二脚长度，而手术扣钉125c的支脚25c具有第三脚长度。特别地，在径向向外的方向上手术扣钉125a-125c高度增加。在一个实施例中，手术扣钉125c的支脚25c具有大约2.3mm的脚长度，手术扣钉125b的支脚25b具有大约3.5 mm的脚长度，而手术扣钉125a的支脚25a具有大约4.1mm的脚长度。同样的，内组织接触表面121c具有最高的高度并保持具有最短脚长度的手术扣钉125c，而外组织接触表面121a具有最低的高度并保持具有最长脚长度的手术扣钉125a。使组织接触表面121逐步阶梯状下降到中间组织接触表面121b并接着再下降到外组织接触表面121a分别导致了手术扣钉扣钉125b和125c的形成。可能的任何数量的布置都是可以想到并且是在本次公开范围内。
虽然将保持槽123的单个环形排119a-119c显示成用于每个组织接触表面121a-121c，但是每个组织接触表面121a-121c可包括多个保持槽的环形排是可以想到并在本次公开范围内的。
如图2中所见，外科吻合器100的扣钉弹射组件106包括设置在钉仓118内的扣钉弹射部件130。扣钉弹射部件130包括具有通常的截头圆锥状的近端部分132和界定了周围有所间隔的缝钉推动器134a-c的同心环的远端部分，每一个缝钉推动器接纳在各自缝钉保持槽123内并与在环形排119a-c内所设置的其对应的手术扣钉125a-c协同作用。在一个实施例中，可以想到将扣钉弹射部件130的近端部分132构造并定制尺寸成能与驱动管138的远端接触。因此，当通过推进驱动管138推进扣钉弹射部件130时，缝钉推动器134a-c将进一步进入保持槽123从而轴向向外推动包含于其中的手术扣钉125。
在可选实施例中，扣钉弹射部件130的缝钉推动器134a-c具有不同的高度用来与不同尺寸的手术扣钉结合。特别地，将缝钉推动器134a-c制成这样尺寸定，使得当将手术扣钉125a-c布置在它们各自环形排119a-c中时，尽管每排手术扣钉之间脚长度不同，但是手术扣钉125a-c的尖端基本上被定位在相同的平面上。
外科吻合器100进一步包括具有砧头109和砧杆110的圆形砧组件108，该砧杆从其近端延伸并适于接合从钉仓118朝远侧延伸的杆111。砧头109包括布置在其近端的环形砧部件112，其中砧部件112包括至少一排沿其圆周附近形成的扣钉成形凹陷114。在一个实施例中，外科吻合器100包括沿其圆周附近形成的扣钉成形凹陷114的三个横向间隔排。每个扣钉成形凹口114与相应的保持槽123重合。
虽然在图2中将砧部件112显示成具有基本平面的组织接触表面，但是具有多种可选的构造是可以想到并且在本公开的外科吻合器100范围内的。例如，如图3A中所见，砧部件112可具有将形状制成与钉仓118的阶梯状组织接触表面121形状(阶梯状)互补的组织接触表面112a，或者如图3B中所见，砧部件112可具有阶梯状组织接触表面112b而钉仓118的组织接触表面121基本上是平面的。另外，例如，如图3C中所见，砧部件112可具有比砧钉凹口114a或114c向砧部件112内延伸更长距离的一排钉凹口114b，用来容纳具有更长腿长的手术扣钉，或者如图3D中所见，砧部件112可具有与钉仓118的组织接触表面121对称的阶梯状组织接触表面112d(即砧部件112的组织接触表面112d的单个组织接触表面的深度基本上等于钉仓118的单个组织接触表面121a-121c的深度)。
选择手术扣钉125a-125c的尺寸并试图用在肥胖症处理所需的典型的胃灼烧(gastric firings)中。然而，例如将所选的手术扣钉125a-125c的尺寸选定为用于在不同类型组织中进行施用，例如结肠、肠、肺、支气管、肺血管、肝等等，是可以想到并在本次公开范围内的。
应用中，将外科吻合器100放置在患者身体内的管状器管中并将待连接的脏器的端部放置在钉仓118和砧组件108之间的间隙中。按照惯例，在砧组件108接近钉仓118之前通过荷包缝合可将脏器的端部固定在砧杆110的周围。接着将外科吻合器100靠近并弹射。手术缝合装置和其使用方法的例子公开在U.S.专利No.5,91 5,616中，该专利目前转让给Tyco医疗健康集团，其整个内容作为参考结合于此。
现在回到图4和图7，根据本公开的另一实施例，用于执行手术吻合缝合的胃肠吻合类型的外科吻合器通常指代为200。外科吻合器200包括第一手柄202，该第一手柄具有界定了从其远端延伸的钉仓接收部分的钳夹203，在钳夹203中可接纳钉仓204，第二手柄206，该第二手柄具有界定了从其远端延伸的砧部件接收部分的钳夹205，以及与钳夹205可操作地连接的砧部件208。第一和第二手柄202、206构造成这样使得钉仓204基本上与砧部件208对准。
如图7中所见，钉仓204包括阶梯状组织接触表面121，其包括外组织接触表面121a、中间组织接触表面121b和内组织接触表面121c，当从钉仓204的底部表面231测量它们时，每一个组织接触表面具有相互不同的高度。组织接触表面121a-121c是基本上彼此平行的平面结构，但不是彼此共面的。例如，如图7中所示，组织接触表面121a-121c在从刀具路径222垂直向外的方向上高度降低。在不包括刀具路径222的实施例中，组织接触表面121a-c在从钉仓204的中心线垂直向外的方向上高度降低。
每个组织接触表面121a-121c包括形成于其中的保持槽123的各自线型排119a-119c。将线型排119a-119c的每个保持槽123构造并定制尺寸成能够在其中保持手术扣钉125。槽123的每个线型排119a-119c包括具有其自有性能特征的相应的手术扣钉125a-125c。
如图7中所见，手术扣钉125a的支脚25a具有大约4.1mm的脚长度，手术扣钉125b的支脚25b具有大约3.5mm的脚长度，以及手术扣钉125c的支脚25c具有大约2.3mm的脚长度。特别地，手术扣钉125a-125c在相对朝着可选刀具路径222的垂直向外方向上高度增加。刀具路径222沿钉仓204、310或者412的中心线布置并适于可滑动地接纳可选刀具(未显示)。使组织接触表面121逐步阶梯状下降到中间组织接触表面121b并接着再一次下降到外组织接触表面121a分别导致了手术扣钉125b和125c的形成。可能的任何数量的布置都是可以想到并且在本公开范围内的。
应用中，类似于或者依照其他已知的外科吻合器使外科吻合器200进行弹射。手术缝合装置和其使用方法的例子公开在U.S.专利No.6,202,914中，该专利目前转让给Tyco医疗健康集团，其整个内容作为参考结合于此。
另外参考图8，在外科吻合器200进行弹射后，在截面上可看见缝合后的组织界面。因此，手术扣钉125a和125b(即离刀割线“C”最远的两排手术扣钉)用来彼此握持组织“A”和“B”，而手术扣钉125c(即离刀割线“C”最近的那排手术扣钉)用来提供止血。
虽然外科吻合器200是线型手术缝钉，但是可以想到并在本次公开范围内的是，外科吻合器200可包括具有砧部件和钉仓中的至少一个的剖面轮廓的组织接触表面，其基本类似于砧部件和外科吻合器100的钉仓的组织接触表面，如图3A-3D中所示。
现在回到图5和7，根据公开的另一实施例，用于执行手术吻合缝合的腹腔镜类型的外科吻合器通常指代为300。外科吻合器300包括手柄302、操作用具306，和用于将操作用具306连接到手柄302的伸长杆304。通常，操作用具306设计用来夹住接着卡住分离组织并将分离组织保持于其中。因此，如图5中所见，操作用具306是一对包括彼此枢转连接的砧部件308和钉仓310的相对的钳夹。
外科吻合器300的钉仓310包括类似于外科吻合器200的钉仓204的组织接触表面121的阶梯状组织接触表面121。因此，为了阐明和讨论外科吻合器300的钉仓310的组织接触表面121可参考图7和上面对钉仓204的组织接触表面121的详细讨论。
应用中，类似于或者依照其他已知的外科吻合器使外科吻合器300进行击发。为了详细描述外科吻合器300的靠近和弹射，参考共同转让的U.S.专利No.5,865,361，该专利目前转让给Tyco医疗健康集团，其整个内容作为参考结合于此。
外科吻合器300弹射之后产生的组织界面，如剖面图中所见，基本上类似于如剖面图中所见的外科吻合器100和200弹射之后产生的组织界面。因此，如图16中所见，手术扣钉125a和125b(即离刀割线“C”最远的两排手术扣钉)用来彼此握持组织“A”和“B”而手术扣钉125c(即离刀割线“C”最近的那排手术扣钉)用来提供止血。
虽然外科吻合器300与外科吻合器100相比是线型手术缝钉，但是可以想到并在本次公开范围内的是外科吻合器300可包括具有砧和钉仓中的至少一个的剖面轮廓的组织接触表面，其基本类似于砧和外科吻合器100的钉仓的组织接触表面，如图3A-3D中所示。
现在回到图6、6A、7和7A，根据公开的又一实施例，用于执行手术吻合缝合的横向吻合类型的外科吻合器通常指代为400。外科吻合器400包括手柄402、从手柄402延伸的管筒404以及从管筒404的远端延伸的臂406。外科吻合器400进一步包括垂直固定于臂406远端的砧部件408以及可操作地连接到管筒404的远端用于将一次性钉仓412保持在其上的钉仓接收器410。砧部件408在图6A中做进一步详细地描述，其包括组织接触表面420，其中组织接触表面420具有与保持槽123基本对准的多个凹口425(图7)。当致动外科吻合器400内的致动机构时凹口425和保持槽123之间协同对准形成了完成的手术扣钉125。
外科吻合器400的钉仓412包括类似于外科吻合器200的钉仓204的组织接触表面121的阶梯状组织接触表面121。因此，为了阐明和讨论外科吻合器400的钉仓412的组织接触表面121可参考图7和上面对钉仓204的组织接触表面121的详细讨论。更进一步，钉仓412可包括用于滑动地将刀具(未示出)接收于其中的刀具路径222。
在本公开的进一步实施例中，钉仓412在图7A中进行阐明并在下文中进行详细讨论。钉仓412类似于钉仓412，但是仅包括布置在钉仓412外壁之间的保持槽123的三排119a-c。如以前所讨论的实施例中，每排119a-c包括多个手术扣钉，其中排119a中的手术扣钉具有与排119b中的手术扣钉不同的脚长度，而布置在排119c中的手术扣钉具有不同于排119a和排119b的至少其中一个的脚长度。钉仓的这个实施例不包括刀具路径。组织接触表面125a-c的布置和相互关系与关于图7以前所公开的类似。
应用中，类似于或者依照其他已知的外科吻合器使外科吻合器400进行击发。为了详细描述外科吻合器400的靠近和击发，参考共同转让的U.S.专利No.5,964,394，该专利目前转让给Tyco医疗健康集团，其整个内容作为参考结合于此。
外科吻合器400弹射之后产生的组织界面，如剖面图中所见，基本上类似于如剖面图中所见的外科吻合器100-300弹射之后产生组织界面。因此，如图8中所见，手术扣钉125a和125b(即离刀割线“C”最远的两排手术扣钉)用来彼此握持组织“A”和“B”而手术扣钉125c(即离刀割线“C”最近的那排手术扣钉)用来提供止血。
虽然外科吻合器400与外科吻合器100相比是线型手术缝钉，但是可以想到并在本次公开范围内的是外科吻合器400可包括具有砧和钉仓中的至少一个的剖面轮廓的组织接触表面，其基本类似于砧和外科吻合器100钉仓的组织接触表面，如图3A-3D中所示。
虽然将上面所述和在此所示的每个外科吻合器构造成适合弹射手术扣钉125，但是可以想到并在本次公开的范围内的是用于连接专用两部分扣钉的手术器具的组织接触表面也可具有如在此所示和所述的阶梯状构造。典型的两部分手术扣钉专用器具显示并描述在共同转让的美国专利No.5,573,169中，该专利目前转让给Tyco医疗健康集团，其整个内容作为参考结合于此。
将会理解的是对于本公开的外科吻合器的实施例可进行各种修改。因此，上面的描述不应当被解释为限定而仅是作为实施例的例证。本领域的那些技术人员将会预见在本公开的范围和精神内的其他修改。

Claims (10)

1、一种用于外科吻合器的钉仓，包括：
a)至少第一组织接触表面和第二组织接触表面，所述第一组织接触表面具有第一高度，所述第二组织接触表面具有第二高度，所述第一高度不同于所述第二高度，
b)所述第一组织接触表面和所述第二组织接触表面界定了用于保持手术缝钉的保持槽，
c)所述保持槽中的缝钉，所述第一组织接触表面的缝钉具有第一脚长度，所述第二组织接触表面的缝钉具有第二脚长度，所述第一脚长度不同于所述第二脚长度。
2、如权利要求1的钉仓，其中，所述钉仓是圆形钉仓。
3、如权利要求1的钉仓，其中，
所述钉仓具有第三组织接触表面，所述第三组织接触表面具有第三高度，
所述第三组织接触表面的缝钉具有第三脚长度，并且
所述第一脚长度大约是2.3毫米，所述第二脚长度大约是3.5毫米，所述第三脚长度大约是4.1毫米。
4、如权利要求1的钉仓，其中，所述钉仓是线型钉仓。
5、如权利要求1的钉仓，进一步包括刀具路径。
6、如权利要求5的钉仓，其中，所述第一组织接触表面的缝钉布置在所述刀具路径的附近。
7、如权利要求6的钉仓，其中，所述第一高度高于所述第二高度，并且所述第一脚长度小于所述第二脚长度。
8、一种外科吻合器，包括：
砧，其具有界定了缝钉成形凹陷的砧组织接触表面；
钉仓，其具有：
i)第一组织接触表面和第二组织接触表面，所述第一组织接触表面具有第一高度而所述第二组织接触表面具有第二高度，所述第一高度高于所述第二高度，
ii)所述第一和第二组织接触表面界定的用于保持缝钉的保持槽，和
iii)位于所述第二组织接触表面的保持槽中的缝钉具有比位于所述第一组织接触表面的保持槽中的缝钉更长的脚长度。
9、如权利要求8的外科吻合器，进一步包括第三组织接触表面，所述第三组织接触表面具有第三高度，并且其中位于所述第一组织接触表面的保持槽中的缝钉具有大约是2.3毫米的脚长度，位于所述第二组织接触表面的保持槽中的缝钉具有大约是3.5毫米的脚长度，和位于所述第三组织接触表面的保持槽中的缝钉具有大约是4.1毫米的脚长度。
10、如权利要求9的外科吻合器，其中，所述钉仓界定了一刀具路径，所述第一组织接触表面的缝钉布置在该刀具路径的附近。
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EP2319423A2 (en) 2011-05-11
CA2556129C (en) 2013-12-03
US8113406B2 (en) 2012-02-14
US7407075B2 (en) 2008-08-05
US20070034668A1 (en) 2007-02-15
US20120125972A1 (en) 2012-05-24
US7726538B2 (en) 2010-06-01
US7837079B2 (en) 2010-11-23
CN101791234B (zh) 2012-08-29
US20080035702A1 (en) 2008-02-14
ES2668076T3 (es) 2018-05-16
EP1915954A3 (en) 2008-05-07
EP2322103A3 (en) 2012-08-29
CN1915180B (zh) 2010-07-07
US8123100B2 (en) 2012-02-28
EP2322103B1 (en) 2021-12-22
EP1915954B1 (en) 2013-05-15
US20090152324A1 (en) 2009-06-18
US7726539B2 (en) 2010-06-01
US8272552B2 (en) 2012-09-25
CA2556129A1 (en) 2007-02-15
EP2319423A3 (en) 2013-03-20
US20100108739A1 (en) 2010-05-06
EP2319423B1 (en) 2018-02-14
CN101791234A (zh) 2010-08-04
EP1754445A2 (en) 2007-02-21
JP4994745B2 (ja) 2012-08-08
US20070034666A1 (en) 2007-02-15
JP2012148099A (ja) 2012-08-09
JP2007050253A (ja) 2007-03-01
EP1915954A2 (en) 2008-04-30
US8292146B2 (en) 2012-10-23
US20080164297A1 (en) 2008-07-10
AU2006203500A1 (en) 2007-03-01
ES2424755T3 (es) 2013-10-08
US7481349B2 (en) 2009-01-27
AU2006203500B2 (en) 2012-03-22
EP2322103A2 (en) 2011-05-18
US20090030432A1 (en) 2009-01-29
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