CN1933785A - 带有改进的切割环的砧座组件 - Google Patents

带有改进的切割环的砧座组件 Download PDF

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CN1933785A
CN1933785A CNA2005800088717A CN200580008871A CN1933785A CN 1933785 A CN1933785 A CN 1933785A CN A2005800088717 A CNA2005800088717 A CN A2005800088717A CN 200580008871 A CN200580008871 A CN 200580008871A CN 1933785 A CN1933785 A CN 1933785A
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CN100475161C (zh
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基思·L·米林曼
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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
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • 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
    • 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
    • A61B17/3205—Excision instruments
    • A61B17/32053—Punch like cutting instruments, e.g. using a cylindrical or oval knife
    • 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
    • A61B2017/07257—Stapler heads characterised by its anvil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft

Abstract

一种用于外科吻合器的砧座组件。该砧座组件包括具有主体和盖子的切割环组件。盖子包含其材料具有使外科吻合器的刀可以穿过的第一硬度的第一层和至少一个其材料具有使外科吻合器的刀尽可能少地穿过盖子的大于第一硬度的第二硬度的附加层。

Description

带有改进的切割环的砧座组件
技术领域
本发明涉及用于吻合器的砧座组件。尤其地，本发明涉及具有改进的特别适用于外科吻合器的切割环的砧座组件。
背景技术
吻合就是外科接合分离的中空组织器官部分，因此中空组织器官部分彼此相通。典型地，吻合是在外科手术将中空组织的患病的或有缺陷的部分切除后把剩余的端部连接起来。在环状吻合操作中，器官部分的两端，例如结肠，通过卡钉仪器被接合，该卡钉仪器将环状排列的卡钉钉入各器官部分的端部，并同时清理重叠的组织以使管状通路通畅。清理是通过穿过重叠组织的环状刀片的平移来实现。
一般地，中空组织的患病或者有缺陷的部分是使用能切除中空组织和同时在切口各侧提供一排或者多排卡钉或紧固件的线状吻合装置切除的。卡钉或紧固件缝合了中空组织部分的切口端。在病变或者有缺陷的组织的每一端执行该操作，因此病变或者有缺陷的组织的每一端以及中空组织部分的每一端都被缝合了。随后，使用环状吻合卡钉或紧固件应用装置接合剩下的中空组织部分的端和清理重叠的组织。
在环状吻合卡钉或紧固装置的砧座组件中使用切割环为众人所知。切割环提供了在启动吻合器以加强组织切割期间环状吻合器的环状刀片邻接和/或穿过的邻接面。典型地，切割环由软材料制成，例如聚乙烯，以使刀能一定程度地穿过切割环。在吻合操作里，卡钉可能疏忽所致而被置于环状刀片和切割环之间。在传统的吻合器中，由于切割环是用软材料制成的，典型地，刀片和卡钉之间的接触会把卡钉压入切割环而无法完成切割卡钉。
因此，需要一种改进的不仅能有效地切割组织而且能有效地切割组织中存在的卡钉的外科吻合器。
发明内容
根据本发明，公开了包括改进的切割环组件的用于外科吻合装置的砧座组件。切割环组件包括主体和盖子。主体可以用聚乙烯制成，例如茂金属，尽管可以预期其他构造材料。盖子可以用多个材料层制成。在一个实施例中，盖子包括用聚乙烯制成的第一层、用相对较硬，例如Mylar，的聚酯材料制成的第二层及用更硬的如聚酯的材料制成的第三层。可以想象盖子也可以只包括两层或四层或更多材料层。在一个实施例中，相对软的第一层的厚度大约为0.001(0.0254毫米)英寸，相对硬的第二和第三层的厚度大约为0.002(0.0508毫米)英寸。可以用粘合剂把这些层彼此粘合并与切割环的主体粘合。可选地，可以使用其他已知的固定技术。
切割环组件盖子的第一层被安置用于啮合外科吻合装置的刀片。第一层较软使刀片能穿过切割环组件以易于刀片切割组织。第二层及第三层较硬能够基本防止或者使刀片尽可能少地穿入切割环组件以易于切割位于将被外科吻合装置接合的组织内，可能由于疏忽被置于刀片和切割环之间的卡钉。
附图说明
这里将参照附图对本发明公开的砧座组件的各种实施例进行说明，其中：
图1为本发明的一个实施例的头组件处于倾斜位置的砧座组件的从近端看的侧视图；
图2为图1所示的头组件处于倾斜位置的砧座组件从远端看的侧视图；
图3为图1所示的砧座组件从近端看的侧视分解图；
图4为图1所示的砧座组件的固定夹的侧视图；
图5为图1所示的砧座组件的固定器部件的侧视图；
图5a为图1所示的砧座组件的切割环组件的正视图；
图5b为沿着图5a中的剖线5b-5b剖切的切割环组件的侧剖视图；
图5c为图5b中指示的细节区域的放大图；
图6为图1所示的头组件处于倾斜位置的砧座组件的侧剖视图；
图7为图6中指示的细节区域的放大图；
图8为图1所示的头组件处于非倾斜或操作位置的砧座组件从远端看的侧剖视图；
图9为图8中指示的细节区域的放大图；
图10为图1所示的头组件处于非倾斜或操作位置且外壳虚构的砧座组件从远端看的侧剖视图；
图11为图1所示的头组件处于部分倾斜位置且外壳虚构的砧座组件从远端看的侧剖视图；
图12为图1所示的头组件处于倾斜位置且外壳虚构的砧座组件从远端看的侧剖视图。
具体实施方式
本发明公开的砧座组件10的实施例将在下面参照附图进行详细描述，其中相同的附图标记在各个视图中表示相同的或相应的部件。
PCT申请号为PCT/US03/31638(“PCT′638申请”)以及临时申请号为60/512,482(“′482申请”)公开了适合采用在此公开的砧座组件的外科吻合装置。这些申请在此全部合并以供参照。
图1-12图示了适用于执行如中空组织器官的环状吻合，痔疮切除及/或矫正操作等外科操作的外科卡钉或紧固件应用装置的砧座组件10。贯穿本说明书的术语“近端”指该装置最接近操作者的部分，而术语“远端”指该装置离操作者最远的部分。尽管本公开主要关注于用于变形卡钉以接合和/或缝合组织部分的砧座组件，可以预见，用于实现对于其他已知类型的紧固件，例如两部分紧固件闭合的砧座组件，像无线电频率缝合装置的赋能缝合装置等，也可以结合本公开的切割环组件使用。更进一步，尽管本公开的切割环组件是结合可倾斜的砧座组件来图示的，可以预见，本公开的切割环组件也可以结合不可倾斜的砧座组件来使用。
如图1-4所示，砧座组件10包括，头组件12和可转动地固定在头组件12上的中心杆组件14。头组件12包括中心的柱16、外壳18、支撑片20、切割环组件22、砧座盘24、固定夹26和间隔部件27。在一个实施例中，外壳18的顶面包括一个或者多个压力释放开口18a(图3)。典型地，柱16通过头18的一个孔(未示出)被基本安置于中心。可选地，头18和柱16可以固有地或者整体地形成到一起。砧座盘24被支撑于外壳18的外环形凹部28中，且包含多个收纳和变形卡钉的卡钉变形窝30。在一个实施例中，至少一个突起24a从砧座盘24沿径向向外延伸并被形成于外壳18的外沿的切口32收纳。突起24a和切口32的作用是对准或适当地定位并保持砧座盘24于外壳18的环形凹部28内。
支撑片20包括一个基本位于中心的开口34，其被环绕置于外壳18的内环形凹部36中的柱16上。内环形凹部36位于柱16和外环形凹部28之间。在一个实施例中，支撑片20包括一个突起的中心平台20a，尽管可以预见其他结构。如图所示，例如，图8中，切割环组件22和支撑片20可滑动地安装于柱16周围。在一个实施例中，支撑片20用像金属的硬材料例如烧结不锈钢制成，并包括一对向内延伸的突起38，其将在下面进行进一步描述。切割环组件22包括主体23和盖子25。在一个实施例中，主体23用比支撑片20软的像聚乙烯的材料例如茂金属制成，并包括内部结构与平台20a基本相同的开口23a，以利于安置切割环组件22于平台20a上。尽管图示的平台20a是环形，可以预见其他的结构，例如正方形，长方形，三角形等。盖子25包括基本位于中心的开口29以收纳柱16。可以使用如粘合剂固定切割环组件22及支撑片20，或者浇铸切割环组件22于支撑片20上。可选地，可以使用其他固定技术来构造支撑片20并固定支撑片20于切割环组件22。
参照图5a-5c，切割环组件22包括盖子25，其中盖子25可以用多个材料层制成。在一个实施例中，盖子25包括通过第二和第三层25b和25c与切割环组件22的主体23隔开的第一层25a，其用相对较软的例如聚乙烯材料制成，第二层25b用相对较硬的聚酯材料例如DuPont公司的Mylar制成，第三层25c用相对较硬的聚酯材料例如Mylar制成。可以预见，盖子25可以用相对较硬的一层或者更多层材料制成且相对软的材料可以被排除。层25a-c可以使用粘合剂25d或其他已知的固定技术固定在一起。第一层25a相对于第二和第三层25b和25c较软，以允许外科器械的刀片能穿入切割环组件22中以加强组织切割。第二和第三层25b和25c的硬度大于第一层25a的硬度以提供更刚硬的支撑以切割疏忽所致进入到外科吻合装置的刀片和切割环组件22之间的卡钉。在一个优选实施例中，第一层25a的厚度范围大约在0.0005英寸和大约0.0015英寸之间，理想的厚度大约为0.001英寸(0.0254毫米)，第二和第三层的厚度范围大约为0.0015英寸和大约0.0025英寸之间，且理想的厚度大约为0.002英寸(0.0508毫米)。可选地，其他不同厚度的材料也可以用于构造切割环组件22的盖子25的不同层。而且，其他材料构造可以用于制成相对较硬的材料层，例如辫成麻花状的、编织的、纺织的及非纺织的材料。
参照图3和5，间隔部件27是环形的且被安置于内环形凹部36内，位于支撑片20和外壳18的后壁之间。在一个实施例中，间隔部件27用像不锈钢或铝这样的金属制成，且包括多个可变形的用于啮合支撑片20的后面的突起27a。间隔部件27防止支撑片20和切割环组件22移动或者被推进外壳18的内环形凹部36中，直到能充分使突起27a变形的预先设定的力被施加于支撑片和切割环组件。在一个实施例中，预先设定的力接近于但是小于吻合装置被启动时，吻合装置的环形切割刀片施加于切割环组件上的力。在一个实施例中，预先设定的力在大约10磅(4.55公斤)和大约90磅(40.9公斤)之间，在另一个实施例中，预先设定的力可以是大约50磅。当达到预先设定的力，例如切割组织时，支撑片20和切割环组件22将进入外壳18的内环形凹部36并压迫间隔部件27。可以预见，其他可压碎的，可变形的，可折叠的或者移动受限的组件也可以用于保持支撑片和切割环组件在一固定位置，直到预先设定的力已经施加于支撑片和切割环组件。
再参照图6和7，砧座中心杆组件14包括中心杆52，插头54和插头弹簧56。中心杆52的第一端有一个偏离中心杆52的中心纵向轴的横向通孔58(图3)。砧座头组件12的柱16还包括横向通孔60(图3)。枢轴部件62通过通孔58和60枢转地将柱16与中心杆52固定，因此砧座头组件12枢转地安装于砧座中心杆组件14上。
插头54可滑动地安置于形成在中心杆52的第一端的孔64内(图6)。插头54包括图7所示的偏离砧座头组件12的枢转轴的啮合销66，并通过插头弹簧56与柱16(图3)的底部16a偏置啮合，以促使砧座头组件12从中心杆52上的非倾斜或操作位置至转动或倾斜位置。在一个优选的位置上，如图3所示的形成于支撑片20上的从支撑片20延伸进入支撑片20的中心开口34的突起38，与中心杆52的顶面52a(图8a)啮合，以防止砧座头组件12绕枢轴部件62旋转。当砧座组件10附着于外科吻合装置且该装置如同PCT申请′638和′482所公开的那样启动时，支撑片20和切割环22被环形刀(未示出)推入环绕柱16的外壳18的内环形凹部36内，以移动突起38脱离与中心杆52(图10)的顶面52a的啮合，并使插头54将砧座头组件12绕枢轴部件62枢转。间隔部件27防止支撑片和切割环组件疏忽所致或提前的移动以防止头组件12提前或疏忽所致的倾斜。
固定夹26设置于形成在柱16上的横向狭槽72(图3)内，并包括一对向外偏斜的挠性臂74和76(图4)。臂76包括尺寸可以收纳枢轴销62的凹部78。每一个臂74和76分别地有一个轴肩74a和76a。在一个实施例中，固定夹26用像不锈钢这样的金属制成，尽管可以预见其他构造材料。在支撑片和切割环组件移动进入内环形凹部36内之前，支撑片20被放置于柱16上以促使固定夹26的臂74和76向内移到柱16的横向狭槽72内的某一位置(图7)。当支撑片20被外科吻合器(未示出)的刀推入到外壳18的内环形凹部36后，挠性臂74和76向外径向弹至轴肩74a和76a被放置于支撑片20和切割环组件22的前面(图9)的位置。在该位置，当砧座组件10从外科吻合装置的卡钉接合外壳部分移走时，臂74和76防止切割环组件22和支撑片20粘附在刀上。
再回到图6和7，中心杆52的第二端包括固定多个挠性臂82的孔80。每个挠性臂82包括开口82a，其尺寸可以收纳形成于或连接到套管针(未示出)上的凸台，或者收纳可连接到砧座固定器轴(未示出)的转接器，以可拆卸地固定套管针到中心杆52上或可拆卸地固定转接器至砧座固定器轴。每个挠性臂82的端部包括内轴肩84，其尺寸可以可拆卸地啮合砧座固定器轴或凸台或连接到外科吻合装置的转接器，以固定砧座组件到外科吻合装置上。多个花键86形成在中心杆52周围。花键86的功能为把砧座组件10和外科吻合装置的卡钉保持部分对准。中心杆52还包括环状凹部90以使外科医生易于使用抓取器抓取砧座组件10。
可以理解，可以对在此公开的实施例进行各种修改。例如，在此公开的构造材料可以用其他具有必备强度要求的构造材料替代。而且，砧座组件可以是可移动的类型，如图所示，或者可以永久固定在外科吻合器上。因此，上面的描述不应解释为限于此，而仅仅是实施例的范例。

Claims (22)

1、一种砧座组件，包括：包含支撑具有多个卡钉变形窝的砧座盘的外壳和被支撑在外壳内部且与砧座盘临接的切割环组件的头组件。切割环组件包括主体和固定在主体上的盖子，盖子包括用具有使外科吻合器的刀可以穿过的第一硬度的第一材料制成的第一层和至少一个用具有尽可能少使外科吻合器的刀穿过的硬度的第二更硬材料制成的附加层。
2、如权利要求1所述的砧座组件，其中该至少一个附加层包括第二层和第三层，第二和第三层用第二更硬材料制成，以使外科吻合器的刀尽可能少地穿过切割环组件。
3、如权利要求2所述的砧座组件，其中盖子的第一层用聚丙烯制成，第二和第三层用聚酯制成。
4、如权利要求3所述的砧座组件，其中第一层的厚度大约为0.001英寸，第二和第三层每个的厚度大约为0.002英寸。
5、如权利要求1所述的砧座组件，其中盖子用粘合剂固定在主体上。
6、如权利要求5所述的砧座组件，其中用粘合剂把第一层固定在该至少一个附加层上。
7、如权利要求1所述的砧座组件，其中砧座盘和切割环组件是环状的，且切割环组件被安置于砧座盘限定的凹部内。
8、如权利要求7所述的砧座组件，其中头组件进一步包括从外壳延伸的中心柱，砧座盘和切割环组件被安置于中心柱的周围。
9、如权利要求8所述的砧座组件，进一步包括从中心柱向外延伸的砧座中心杆。
10、如权利要求9所述的砧座组件，其中砧座中心杆包括多个与中心柱有间隔的挠性臂，该挠性臂适合于可拆卸地与外科器械啮合。
11、如权利要求10所述的砧座组件，其中砧座中心杆枢转地固定在中心柱上，以使头组件从操作位置枢转到非操作的减低的轮廓位置。
12、如权利要求11所述的砧座组件，进一步包括用于促使头组件至非操作位置的偏置部件。
13、如权利要求12所述的砧座组件，其中头组件进一步包括被安置于位于外壳和切割环组件之间的中心柱周围的支撑片，切割环组件被固定在支撑片上。
14、如权利要求13所述的砧座组件，其中支撑片由金属制成。
15、如权利要求13所述的砧座组件，其中支撑片可在中心柱上从第一位置滑动到第二位置，且包括至少一个销，该至少一个销能在支撑片处于第一位置时防止头组件从操作位置移动到非操作位置。
16、一种用于砧座组件的切割环组件，包括：主体和固定在主体上的盖子，盖子包括用具有使外科吻合器的刀穿过盖子的第一硬度的第一材料制成的第一层和至少一个用具有尽可能少使外科吻合器的刀穿过盖子的大于第一硬度的第二硬度的第二材料制成的附加层。
17、如权利要求16所述的切割环组件，其中盖子的第一层用聚丙烯制成，且该至少一个第二层用聚酯制成。
18、如权利要求1所述的切割环组件，其中第一层的厚度为大约0.001英寸，且该至少一个第二层的厚度为大约0.002英寸。
19、如权利要求17所述的切割环组件，其中使用粘合剂把第一层和第二层固定在一起。
20、如权利要求19所述的切割环组件，其中使用粘合剂把盖子固定在主体上。
21、如权利要求16所述的切割环组件，其中该至少一个的附加层包括第二层和第三层。
22、如权利要求17所述的切割环组件，其中主体用聚乙烯制成。
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CN104224265A (zh) * 2008-08-12 2014-12-24 柯惠Lp公司 手术用倾斜砧座组件
CN104107078A (zh) * 2013-04-19 2014-10-22 瑞奇外科器械(中国)有限公司 吻合器及其钉砧组件
CN110313959A (zh) * 2018-03-28 2019-10-11 柯惠Lp公司 用于手术缝合器械的手术砧座组件
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CN113164171A (zh) * 2018-12-06 2021-07-23 柯惠有限合伙公司 具有改进的切割环组合件的砧座组合件
CN110974330A (zh) * 2019-12-09 2020-04-10 杭州市第一人民医院 一种经口腔置入的折叠式管型吻合器钉砧座

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