CN100548225C - 装有带回位弹簧回转式手动退回系统的多冲程击发机构的外科吻合器械 - Google Patents

装有带回位弹簧回转式手动退回系统的多冲程击发机构的外科吻合器械 Download PDF

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CN100548225C
CN100548225C CNB2006100037336A CN200610003733A CN100548225C CN 100548225 C CN100548225 C CN 100548225C CN B2006100037336 A CNB2006100037336 A CN B2006100037336A CN 200610003733 A CN200610003733 A CN 200610003733A CN 100548225 C CN100548225 C CN 100548225C
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弗雷德里克·E·谢尔顿四世
凯文·罗斯·多尔
道格拉斯·B·霍夫曼
迈克尔·厄尔·塞特瑟
贾弗里·S·斯韦兹
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    • E—FIXED CONSTRUCTIONS
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    • E04H—BUILDINGS OR LIKE STRUCTURES FOR PARTICULAR PURPOSES; SWIMMING OR SPLASH BATHS OR POOLS; MASTS; FENCING; TENTS OR CANOPIES, IN GENERAL
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Abstract

一种特别适合内窥镜手术的外科吻合和切割器械，其装有产生独立的闭合和发射运动以致动端部执行器的手柄。具体地，该手柄形成多个击发冲程以便减小击发(例如缝合和切断)端部执行器所需的力的大小。链式传动减小了所需的手柄纵向长度，在为了发射而被拉直时，也获得了刚性而坚固的结构。受牵引偏压的发射机构与防倒转机构相配合避免了在驱动这一拉直的链式齿条时发生束缚，同时锁定机构防止了在发射期间释放闭合触发器。此外，外部指示器给外科医生提供反馈，可让其知道发射已进行了多远，也提供了手动退回的能力。

Description

装有带回位弹簧回转式手动退回系统的多冲程击发机构的外科吻合器械
交叉引用的相关申请
本发明与序列号为No.11/052,632的共同所有的美国专利申请相关，该申请与本申请同一天提交，发明名称为“具有行程退回的自由端的多冲程机构”，其发明人为Kevin Ross Doll，Jeffrey S.Swayze，Frederick E.Shelton IV和Douglas B.Hoffman，该申请所披露的内容在此全部被引用作为参考。
本发明总的涉及能够在切割位于缝合线之间的组织的同时向组织施加多排缝钉的外科吻合器械，更具体地，本发明涉及有关吻合器械的改进和对形成如下所述吻合器械的各种零件的方法的改进，即，该吻合器械利用触发器的多个冲程完成击发。
发明背景
由于较小的切口能减少术后恢复的时间及并发症，所以内窥镜外科手术器械经常比传统的开放式外科手术装置更优选。因此，在适于通过套管针的插管将远端执行器准确地放置在所需手术部位的内窥镜外科手术器械领域中已经有了很大发展。这些远端执行器以多种方式接合组织以获得诊断或治疗的效果(例如，内切割器，抓钳，切割器，缝合器，夹具施放器，接触装置，药物/基因治疗输送装置，以及使用超声波、RF、激光等的能量装置)。
已知的外科吻合器包括端部执行器，其可同时在组织上形成纵向切口和在该切口的相对侧上施加数排缝钉。该端部执行器包括一对协同操作的钳口构件，如果将该器械用于内窥镜或腹腔镜用途，则该钳口构件能够穿过插管通路。其中一个钳口构件容放具有至少两排横向间隔开的缝钉的钉匣。另一钳口构件限定了一砧座，该砧座具有与钉匣内的数排缝钉对准的缝钉形成凹座。该器械包括多个往复的楔形件，在其被朝远侧驱动时，其穿过钉匣上的开口并与支撑缝钉的驱动器接合，以朝砧座发射缝钉。
在美国专利No.5,465,895中描述了适于内窥镜应用的外科吻合器的一个实例，其有利地提供了不同的闭合及发射动作。因此，临床医生能够在组织上闭合钳口构件以在发射前定位组织。一旦临床医生确定钳口构件已经准确地抓紧组织，临床医生就可以随后击发有单个击发冲程的外科吻合器，由此切断并缝合组织。同时切断和缝合避免了当使用不同的分别仅完成切割或缝合的外科手术工具而相继完成这些动作时可能出现的并发症。
能够在击发前闭合在组织上的一个具体优点在于，临床医生能通过内窥镜检验是否已经到达了用于切割的所需部位，包括在相对的钳口之间已经捕捉到足够数量的组织。否则，相对的钳口可能被过紧地拉到一起，特别是在它们的远端处夹紧，因此不能在被切断的组织上有效地形成闭合的缝钉。在其他极端的情况下，被夹紧的过多的组织可能导致采缚及不完全击发。
一般地，在单个闭合冲程之后有单个击发冲程是进行切割和缝合的一种方便而有效的途径。然而，在一些情况下，会需要多击发冲程。例如，外科医生能够从钳口尺寸的范围中选择用于所需的切割长度的对应钉匣长度。较长的钉匣需要较长的击发冲程。因此，为了进行击发，需要手压式触发器来对较长的钉匣施加较大的力，以便比较短的钉匣切割更多的组织和驱动更多的缝钉。力的大小可能需要小一些，以便不会超过一些外科医生的手劲。另外，一些不熟悉较大钉匣的外科医生可能担心在需要意料不到的较大的力时出现束缚或其它错误动作。
一种用于降低击发冲程所需的力的方案是使用允许发射触发器被多次动作的棘轮机构，如在美国专利Nos.5,762,256和6,330,965中描述的那样。这些已知的带有多冲程发射机构的外科吻合器械不具有分开的闭合和发射动作的优点。此外，棘轮机构依赖于齿条及驱动棘爪来完成啮合运动，并且包含这些组件的手柄长度由此增加以适应齿条。这一增加的长度是不方便的，使闭合受到限制并增加了与外科手术相关联的设备数量。
尽管这些多击发冲程机构会具有一些优点，但单击发冲程机构的一些特征也具有优点。例如，甚至在释放发射触发器期间，单冲程发射触发器也可被直接联接到发射机构上。因此，在单冲程发射触发器上的任何弹簧偏压都有助于刀从端部执行器退回。如果出现束缚，则由于发射触发器直接联接于发射机构上，所以外科医生可朝外推动发射触发器来实现退回。
相反，在返回冲程期间，多冲程发射触发器不与发射机构相联。尽管有利地引入了退回偏压力以使刀从缝钉施加组件退回，但由此需要防止这个退回力在完成整个击发行程之前使刀退回。因此，希望退回力适度，以便不增加在发射触发器处感到的手动力。另外，退回力适度也不会使防倒转机构过载。
但是，在需要帮助来退回发射机构时出现这些情况。否则，可能难以从夹紧的组织上释放端部执行器，从而完成手术过程。例如，组织可能在器械中引起束缚。作为另一个例子，可能发生将增加在器械内的束缚或者否则减小退回力的故障。利用在返回冲程中不联接的多冲程发射触发器，可获得使发射机构退回的另一种方式。作为另一个例子，可能已部分地开始了发射动作，但医生判断发射必须停止且端部执行器打开。如果在端部执行器中的钉匣用光且发生部分发射，在锁定器械而不进行进一步的发射之前，会发生这种情况。
因此，十分需要具有多冲程发射机构的外科吻合器械，该发射机构可在整个击发行程之后自动退回。
本发明通过提供一种如下所述的外科吻合和切断器械克服了现有技术的上述和其他缺陷，即，该器械包括响应纵向击发动作而进行外科手术的端部执行器。该端部执行器以在体外操纵一经由轴而固定在端部执行器上的手柄的方式经过一身体开口(例如套管针的插管)来定位。该手柄向滑动地装放在轴中的击发构件产生由发射机构通过齿条施加的击发运动。齿轮机构随齿条转动，以使可从体外在手柄上看到的退回构件运行。由此，使用者能够手动地帮助退回发射机构。
在本发明的一个方面中，外科器械的手柄具有一发射机构，该机构响应由发射触发器引起的多个击发冲程，使齿条并由此使发射构件沿轴前进。回位弹簧朝近侧将发射构件偏压离开所述轴以帮助退回。为了防止在击发冲程间出现意外的退回，防倒转机构响应其近侧运动而约束发射构件，在击发之后，防倒转解除机构为进行退回而脱开防倒转机构。有利的是，手动退回机构具有通过一单向离合器连接到一从外部可接触的制动器上的传动齿轮。因此，在自动退回不能够实现退回时可提供帮助。这避免了端部执行器可能在闭合且夹紧的状态下保持在被吻合和切断的组织上的情况。
(1)根据本发明的一种外科器械，包括：端部执行器，其响应纵向发射运动来进行外科手术操作；与所述端部执行器连接的轴；发射构件，其由所述轴滑动地接收，以在非发射位置和完全发射位置之间将发射运动传递给端部执行器；固定在发射构件上的齿条；发射机构，其在操作上被构造成在击发冲程中与齿条接合且使其向远侧运动，并在随后脱开接合；与所述齿条啮合的齿轮机构；包含齿条、发射机构和齿轮机构的手柄；以及退回构件，其安装在手柄外部上以便进行旋转，且联接于齿轮机构上以便进行旋转。
(2)如第(1)项所述的外科器械，其中，所述齿轮机构进一步包括与所述齿条联接以与之成比例地转动的传动齿轮，所述退回构件包括一刻度盘，其包含把手构件，用于指示发射行程的量以及由使用者致动来反向驱动传动齿轮和齿条。
(3)如第(2)项所述的外科器械，进一步包括：发射触发器；所述发射机构在操作上被进一步构造成通过在击发冲程之间脱开发射触发器而响应多个击发冲程来实现最大击发行程；回位弹簧，其在近侧固定于齿条上，以维持其上的退回力；防倒转机构，其被偏压以在击发冲程之间束缚发射构件；以及防倒转解除机构，其在发射后脱开防倒转机构。
(4)如第(1)项所述的外科器械，其中，所述齿轮机构进一步包括与齿条连接的惰轮，当齿条向远侧运动时，该惰轮沿第一方向旋转，当该齿条向近侧运动时，该惰轮沿第二方向旋转，该惰轮连接于单向离合器上，该单向离合器又与退回构件联接，该单向离合器在操作上被构造成当使退回构件沿第一方向相对于惰轮旋转时脱离接合。
(5)如第(1)项所述的外科器械，其中，所述齿轮机构进一步包括棘轮，当齿条向远侧运动时，该棘轮沿第一方向旋转，且当齿条向近侧运动时，该棘轮沿第二方向旋转，并且所述退回构件包括齿轮退回杆及退回棘爪，该退回棘爪被定位成在致动齿轮退回杆时接合棘轮以沿第二方向转动棘轮，从而退回齿条和发射构件。
(6)如第(1)项所述的外科器械，进一步包括一回位弹簧，其在近侧固定在齿条上以促使其退回，该退回构件手动地辅助回位弹簧。
(7)如第(6)项所述的外科器械，其中，所述发射机构在操作上被构造成响应多个击发冲程以使发射构件沿轴前进，该外科器械进一步包括：可响应发射构件的近侧运动而接合发射构件的防倒转机构；以及防倒转解除机构，其在操作上被构造成脱开与防倒转机构的接合；其中，联接致动的齿轮退回杆以激活防倒转解除机构。
(8)如第(7)项所述的外科器械，其中，所述防倒转机构包括：锁定盘，其包括沿圆周包围发射构件的孔，该锁定盘在孔锁定地接合发射构件的锁定位置和孔滑动地接合发射构件的解锁位置之间枢转；将锁定盘偏压至锁定位置的防倒转弹簧；以及防倒转解除杆，其被定位成与防倒转弹簧的偏压力相对；其中，所述齿轮退回杆包括一凸轮构件，其被定位成使防倒转解除杆向远侧运动。
(9)如第(7)项所述的外科器械，其中，所述齿轮机构进一步包括：与齿条啮合的惰轮，其大小被设定成响应齿条的最大发射行程转一圈；凸轮，其响应惰轮以在最大发射行程的终点向远侧移动防倒转解除杆；以及与惰轮啮合并包含棘轮的传动齿轮。
(10)如第(7)项所述的外科器械，进一步包括一手柄，其包含齿条、发射机构以及齿轮机构，并进一步包括阻挡结构，其中，所述齿轮退回杆进一步包括一轮毂，其包含尺寸适于接收棘轮的凹槽，还包括被连接成在凹槽内枢转的棘爪以及阻挡机构，该机构被定位成在未致动齿轮退回杆时在棘轮上方保持棘爪。
(11)如第(1)项所述的外科器械，其中，所述端部执行器包括：与所述轴相连的细长通道；与所述细长通道枢转地联接以用于夹紧组织的砧座；以及收纳在所述细长通道内的钉匣；其中，所述发射构件在远侧终止于发射棒，该发射棒在操作上被构造成致动钉匣以在被夹紧组织上形成缝钉，齿轮退回杆的致动将发射棒从端部执行器收回，从而允许端部执行器打开。
(12)根据本发明的另一种外科器械，包括：端部执行器，其响应纵向发射运动来进行外科手术操作；与所述端部执行器连接的轴；发射构件，其由所述轴滑动地接收，以在非发射位置和完全发射位置之间将发射运动传递给端部执行器；以及手柄，其包括：发射触发器，连接于发射构件上的齿条；发射机构，其响应由发射触发器引起的多个击发冲程，从而使齿条并由此使发射构件沿轴前进；回位弹簧，其将发射构件向近侧偏压离开所述轴；防倒转机构，其可响应发射构件的近侧运动而接合以束缚发射构件；防倒转解除机构，其在操作上被构造成为了退回而脱开防倒转机构；以及手动退回机构，其包括与齿条啮合并由单向离合器使其耦合于外部可接近的致动器的惰轮。
(13)如第(12)项所述的外科器械，其中，所述惰轮与凸轮构件接合，当外部可接近的致动器被手动定位以脱开防倒转机构时，该凸轮构件在操作上与防倒转解除机构耦合。
(14)如第(12)项所述的外科器械，其中，手动退回机构的单向离合器进一步包括一棘轮，其为了旋转而与惰轮联接，从而当齿条向远侧运动时其沿第一方向旋转，且当齿条向近侧运动时沿第二方向旋转，并包括连接到外部可接近的致动器上的退回棘爪，当致动外部可接近的致动器时，该退回棘爪被定位成与棘轮接合以使棘轮沿第二方向转动，从而退回齿条和发射构件。
(15)如第(14)项所述的外科器械，其中，所述外部可接近的致动器包括连接到一轮毂上的杆，该轮毂具有包围棘轮和棘爪的凹槽，该轮毂在由所述杆致动时为防倒转解除机构提供凸轮表面，以在退回齿条的同时脱开防倒转机构。
(16)如第(12)项所述的外科器械，其中，该端部执行器包括：与所述轴相连的细长通道；与所述细长通道枢转地联接以用于夹紧组织的砧座；以及收纳在所述细长通道内的钉匣；其中，所述发射构件在远侧终止于发射棒，该发射棒在操作上被构造成致动钉匣以在被夹紧组织上形成缝钉，齿轮退回杆的致动将发射棒从端部执行器收回，从而允许端部执行器打开。
(17)如第(12)项所述的外科器械，进一步包括具有向下的把手的手柄，其中，该齿条进一步包括可向下弯曲成向下的把手的链排。
(18)根据本发明的再一种外科器械，包括：缝钉施加组件；连接于缝钉施加组件上的细长轴；发射构件，其滑动地接收于所述轴中以致动缝钉施加组件，从而缝合及切割组织；手柄，其包括：连接于发射构件的齿条；包括发射棘爪的发射触发器；发射机构，其在操作上被构造成响应发射触发器的致动与发射机构的棘爪接合；与齿条啮合的齿轮机构；外部可接近的手动退回致动器；以及通过操纵外部可接近的手动退回致动器来退回齿条而手动地反向驱动齿轮机构的部件。
(19)如第(18)项所述的外科器械，其中，所述发射机构在操作上被构造成响应多个击发冲程，从而使发射构件沿轴前进，该外科器械进一步包括：防倒转机构，其可响应发射构件的近侧运动而与发射构件接合；以及防倒转解除机构，其在操作上被构造成脱开防倒转机构；其中，用于通过操纵外部可接近的手动退回致动器来退回齿条而手动地反向驱动齿轮机构的部件进一步包括用于致动防倒转解除机构的部件。
(20)如第(19)项所述的外科器械，进一步包括用于在最大发射行程时自动退回发射构件的部件
本发明的这些及其它目的和优点将从附图和对其的描述中显而易见。
附图说明
结合进说明书并成为其一部分的附图示出了本发明的实施例，并且与本发明上述总的描述和下面给出的实施例的详细描述一起用于解释本发明的原理。
图1是张开(开始)状态的外科吻合和切割器械(牵引被压棘爪)的右侧剖视图，并且轴被部分地切除从而露出闭合管和发射杆。
图2是在位于图1中的外科吻合器械远侧部分和的端部执行器的纵截面中沿线2-2截取的左侧剖视图。
图3是图2中端部执行器的前侧透视图。
图4是图1中的外科吻合和切割器械的执行部分的分解透视图。
图5是描绘了图1中外科器械的在图3中所示端部执行器的截面的左侧剖视图，该截面总的沿图3中的线5-5截取，从而露出了钉匣部分，而且描绘了沿纵向中心线的发射杆。
图6描绘了在发射杆已完全发射后的图5中的端部执行器的截面图左侧剖视图。
图7是图1中的外科吻合和切割器械的手柄的左侧剖视图，其中左侧手柄外壳被移除。
图8是图7中手柄的分解透视图。
图9是图7中手柄的链接传输发射机构的从左后侧向下观看的透视图。
图10是图9中发射机构的链接齿条的详细左侧剖视图。
图11-14是总的沿发射机构的链接齿条和棘爪的倾斜中央轨道的纵向轴线的截面的左侧剖视图，并且还示出了发射触发器，牵引偏压机构的偏压轮和斜面，描绘了发射冲程期间的次序。
图15是部分分解以露出图1中所示外科吻合和切割器械的处于锁定状态的防倒转机构(侧面弹出型lateral kick-out type)的远端部分的右侧剖视图。
图16图15中防倒转机构的从右后方向下看的俯视图，并且防倒转凸轮管被移除。
图17是部分分解以露出图1中外科吻合和切割器械的处于未锁定状态的防倒转机构的远侧部分的右侧剖视图。
图18是部分分解以露出图1中外科吻合和切割器械的处于未锁定状态的防倒转机构的远侧部分的右侧剖视图。
图19是图1中外科吻合和切割器械的后侧剖视图，并且其中手柄外壳的右半壳体被移除，以露出点划线所示的处于锁定状态和未锁定状态的防倒转解除杆。
图20-25是图18中防倒转解除杆的详细视图，分别描绘了未发射、一个发射冲程、两个发射冲程、三个发射冲程，返回或解除按钮被压下，以及完全返回的发射序列。
图26-27是外科吻合和切割器械的从左上侧看的透视图，并且移除了手柄外壳的右半壳体，以露出闭合解除闭锁机构，其分别处于闭锁移除以及闭合解除按钮被压下的初始位置，随后在初始发射期间闭锁被激活。
图28是与图1中类似的处于张开状态的外科吻合和切割器械的透视图，但结合有顶部可达退回杆。
图29是图28中外科吻合和切割器械的左侧剖视图，其中移除了手柄外壳的左半壳体以露出间断的带齿指示器齿轮，该齿轮向惰轮提供第一停止区域。
图30是图28中外科吻合和切割器械的左侧剖视图，移除了手柄外壳的左半壳体以露出间断的带齿指示器齿轮，该齿轮向惰轮提供第二停留区域。
图31是一可选的外科吻合和切割器械(弹簧偏压侧棘爪)的从左侧看的主视图，具有可选的手柄部分，其包括第一可选(连杆触发的)自动退回机构及可选的(棘轮)手动退回机构。
图32是图31中外科吻合和切割器械的从右后侧看的透视图，截掉了部分细长轴，并移除手柄外壳的右半壳体以露出自动的击发行程结束退回机构及手动发射退回机构。
图33是图31中的外科吻合和切割器械的手柄部分和延长轴的从右后侧看的分解透视图。
图34是图31中外科吻合和切割器械的从右后侧看的透视图，并且移除右半壳体及执行部分的外部以露出初始状态的闭合及发射机构。
图35是图34中外科吻合和切割器械的部分拆除的右侧剖视视图。
图36是图34中的外科吻合和切割器械的部分拆除的从右后侧看的透视图，其闭合机构闭合并夹紧，并且侧棘爪发射机构完成第一冲程，且移除手动退回机构以露出击发发射机构的自动退回的链接齿条的远侧连杆。
图37是图35中外科吻合和切割器械的部分拆除的从右后侧看的透视图，且侧棘爪发射机构脱离接合，并且远侧连杆接近自动退回。
图38是图35中的外科吻合和切割器械处于初始状态的部分拆除的左视剖视图，其中端部执行器张开并且防倒转机构接合。
图39是图38中手柄部分的右半壳体和第一可选的防倒转解除杆(例如，连杆触发的)的左侧详细视图。
图40是图31中的拆开的外科吻合和切割器械的左侧详细视图，其中闭合触发器夹紧，发射触发器正在进行最后的冲程且远侧连杆定位以启动自动退回。
图41是图40中在远侧连杆已经致动并朝向发阻塞解除杆锁定后、允许链接齿条退回时的外科吻合和切割器械的拆卸的左侧详细视图。
图42是图31中的可选(弹簧偏压侧棘爪的)外科吻合和切割器械的手动退回机构的惰轮、后齿轮、手动退回杆以及棘轮棘爪的从右侧看的透视图。
图43是图42中手动退回机构的从右侧看的透视图，截掉一部分手动退回杆以露出在后齿轮上啮合棘轮棘爪的较小直径的棘轮。
图44是图31中可选外科吻合和切割器械(弹簧偏压侧棘爪)的部分拆除的左侧剖视图，其中防倒转机构啮合于完全发射链接齿条，该齿条在图42中的手动退回杆致动之前与组合拉/压弹簧脱开。
图45是图44中的可选外科吻合和切割器械的部分拆除的左侧剖视图，防倒转解除杆，后齿轮以及手动发射解除杆的隐藏部分，以虚线显示。
图46是图45中在手动发射杆致动已经手动退回链接齿条后的可选外科吻合和切割器械的部分拆除的左侧剖视图。
图47是图46中可选的外科吻合和切割器械的部分拆除的左侧剖视图，省略了链接齿条，描绘了手动发射解除杆与防倒转机构脱开的情况。
图48是用于图31中外科吻合和切割器械(弹簧偏压侧棘爪)的第二可选的防倒转解除杆(齿轮由凸轮带动向前)以及手柄外壳的左侧详细视图。
图49是图48中第二可选的防倒转解除杆(齿轮由凸轮带动向前)，后齿轮轮轴以及自动退回凸轮的从左侧看的分解透视图。
图50是图48中的第二可选防倒转解除机构的右侧剖视图，其中链接齿条位于退回位置且防倒转解除杆在近侧定位，且防倒转盘与发射杆接合。
图50A是图50中后齿轮，自动退回凸轮及最远侧连杆的右侧详细视图。
图51是图50中第二可选的防倒转解除机构在第一发射冲程后的右侧剖视图。
图51A是图51中后齿轮，自动退回凸轮及第二连杆的右侧详细视图。
图52是图51中第二可选的防倒转解除机构在第二发射冲程后的右侧剖视图。
图52A是图52中的后齿轮，自动退回凸轮及第三连杆的右侧详细剖视图。
图53是图52中的第二可选的防倒转解除机构在第三发射冲程及最后冲程后的右侧详细剖视图。
图53A是图53中的后齿轮，自动退回凸轮及最近侧第四连杆的右侧详细剖视图。
图54是图53中第二可选的自动解除机构在又一发射冲程后致使自动退回凸轮向远侧滑动并锁住第二可选的防倒转解除杆，与防倒转机构脱离接合的右侧剖视图。
具体实施方案
不论是否具有整体齿条或是具有有利地描述为用于较短手柄的链接齿条，外科吻合和切割器械都结合有多发射冲程能力，允许较大的击发行程而不需要挤压发射触发器的过大的力。在发射冲程之间采用了防倒转机构，从而使发射退回偏压不会造成无意的发射退回。
在图1-30中，外科吻合和切割器械的第一种形式结合有侧移防倒转解除机构，该机构导致在发射行程结束后自动退回。这种形式还包括手动退回辅助能力的第一种形式，以克服束缚。在图31-54中，外科吻合和切割器械的第二种形式包括另外两个防倒转解除机构，用于在发射行程结束后的自动退回。另外，图1-30中的外科吻合和切割器械的第一种形式通过摩擦偏压的顶部棘爪将来自发射触发器的发射运动联接至链接齿条传输机构。图31-54中的外科吻合和切割器械的第二种形式通过弹簧偏压的侧棘爪将发射触发器的发射运动联接到链接齿条传输机构。此外，图32-41中的外科吻合和切割器械的第二种形式描述了齿条触发的自动退回能力，采用棘轮手动退回机构代替图1-30中的弹出(kick-out)防倒转解除杆。对应于图32-41中总体描述的内容，在图42-47中更加详细地描绘了棘轮手动退回机构。图48-54描绘了内置入指示和棘轮手动退回机构的齿轮驱动自动退回部件，作为图1-30中弹出式防倒转解除杆，以及图31-47中的齿条触发防倒转解除杆的另一可选方式。
参见附图，其中在所有的附图中相同的附图标记代表相同的组成元件，图1和2中描绘了外科吻合和切割器械10，其能实现本发明独特的优点。该外科吻合和切割器械10带有端部执行器12，该端部执行器具有与细长的通道16可枢转地连接的砧座14，从而形成了相对的钳口，以用于夹紧待切割和吻合的组织。该端部执行器12通过轴18联接到手柄20(图1)。由端部执行器12和轴18形成的执行部分22，其尺寸可有利地插入穿过套管针或小的腹腔镜开口，从而在外科医生抓住手柄20进行控制时执行内窥镜手术进程。该手柄20有利地包括允许分开的闭合运动和发射运动及闭锁的部件，从而避免无意地或不当的发射端部执行器，以及在给外科医生指示发射程度的同时多发射冲程所引发的端部执行器12的发射(例如切割和吻合)。
为了这些目的，轴18的闭合管24在闭合触发器26(图1)和砧座14之间联接，以使端部执行器12闭合。在闭合管24之中，框架28在细长通道16和手柄20之间联接以沿纵向定位并支撑端部执行器12。旋钮30与框架28联接在一起，且这两个元件可相对于绕轴18的纵向轴线的旋转运动旋转地与手柄20联接在一起。因此，外科医生能通过转动旋钮30来旋转端部执行器12。闭合管24也可通过旋钮30来旋转，但相对它保持了一定程度的纵向运动，以使端部执行器12闭合。在框架28内设置了发射杆32，用于纵向运动，并将其联接在端部执行器12的砧座14与多冲程发射触发器34之间。该闭合触发器26位于手柄20的手枪式握把36的远侧，并且发射触发器34位于手枪式握把36和闭合触发器26的远侧。
在内窥镜操作中，一旦执行部分22插入病人体内进入手术位置，外科医生参照内窥镜或其它诊断成像装置来将组织定位在砧座14与细长通道16之间。外科医生抓住闭合触发器26和手枪式握把36可重复地抓住及定位组织。一旦对组织相对于端部执行器12的位置以及其中的组织数量都满意的话，外科医生朝向手枪式握把36完全压下闭合触发器26，从而在端部执行器12中夹紧组织并将闭合触发器26锁定在这一夹紧(闭合)位置。如果对这一位置不满意，外科医生可通过压下闭合解除按钮38来解除闭合触发器26并随后重复夹紧组织的过程。
如果夹紧是正确的，外科医生可继续进行外科吻合和切割器械10的发射。具体地说，外科医生抓住发射触发器34和手枪式握把36，以预定次数按压发射触发器34。必需的发射冲程的数量是基于下述因素以人机工程学的方式确定的，即，手的最大尺寸，每次发射冲程期间施加给器械的最大力，以及发射期间要通过发射杆32传输至端部执行器12的纵向距离和力。如在下面的讨论将理解的那样，不同的外科医生可选择以不同的运动角范围转动发射触发器34，并且由此增加或减少发射冲程的数量，而手柄20仍引发发射而没有束缚。
在这些冲程期间，外科医生可以参考指示器，该指示器描绘为指示退回旋钮40，其对应于多发射冲程来定位旋转。另外，退回旋钮40的定位可确定当发射触发器34的进一步旋转遇到阻力时是否已发生完全发射。需要理解的是，不同的标记和指示可添加到手柄20中来加强由指示旋转按钮40的旋转所提供的指示。在发射杆32进行到整个行程时及当解除发射触发器34时，手柄20自动地收回发射杆32。可选择的是，在知道外科吻合和切割器械10如指示退回旋钮40所描绘的那样并没有完全发射的情况下，外科医生可按下防倒转解除按钮42并解除发射触发器34。这些动作都允许手柄20自动地收回发射杆32。
要理解的是，在这里使用的术语“近侧”和“远侧”是参照临床医生握住器械的手柄而言。因此，端部执行器12相对于更近侧的手柄20而言位于远侧。类似的术语，例如“前”和“后”也类似地分别对应于远侧和近侧。还需要理解的是，为了方便和清楚，这里使用的空间术语“垂直”和“水平”是相对于附图而言。然而，外科器械应用于许多方位和位置，且这些术语并不是用于限制也不是绝对的。
本发明是就内窥镜进程及装置来进行讨论的。然而，这里使用的术语例如“内窥镜的”，并不能解释为将本发明限制为仅与内窥镜管(例如套管针)一同使用的外科吻合和切割器械。相反地，可以相信本发明可以找到各种进程中的应用，这些进程的入口限制为小的切口，包括但并不局限于腹腔镜进程，以及开放式进程。
E形梁端部执行器
能提供多冲程发射运动的手柄20的好处是可应用于许多带有一个图2-6中描绘的端部执行器12的器械。特别参考图4，端部执行器12首先通过包括连接到砧座近端52的砧板表面50(图2，4，6)响应于来自手柄20(未示于图2-6)的闭合运动，该砧座近端52包括一对沿横向凸出的砧座轴销54，其靠近垂直凸出的砧座部件56(图4)。该砧座轴销54在细长通道16中的卵形开口58内平移，以相对于细长通道16开启及闭合砧座14。砧座部件56与在闭合管24的远端62上的片孔60中向内延伸的弯片59(图2，4，6)接合，后者在远侧终止于压在砧板表面50上的远侧边缘64。因此，当闭合管24从其开放位置向近侧运动时，闭合管24的弯片59向近侧拉动砧座部件56，且砧座轴销54随着细长通道16的卵形开口58而运动，从而导致砧座14同时向近侧平移并向上旋转至开放位置。当闭合管24向远侧运动时，片孔60中的弯片59从砧座部件56处解除，且远侧边缘64推压在砧板表面50上，从而闭合砧座14。
仍参考图4，执行部分22还包括响应于发射杆32的发射运动的组成元件。特别地，发射杆32与具有纵向凹槽68的发射槽构件66可旋转地接合。发射槽构件66直接响应于发射杆32的纵向运动而在框架28内纵向运动。闭合管24上的纵向狭缝70可操作地与旋钮30(未示于图2-6)相联接合。闭合管24内的纵向狭槽70的长度足够长，从而允许随着旋钮30的相对纵向运动，以实现随着通过框架28内纵向狭槽72传递的旋钮30的联接器的发射闭合运动，以与框架槽构件66内的纵向凹槽68滑动接合。
框架构件66的远端连接到发射杆76的近端，该发射杆76在框架28内运动，特别是在其中的导向件78内运动，以向远侧伸出E形梁80进入端部执行器12。该端部执行器12包括钉匣82，该缝钉匣由E形梁80致动。该钉匣82具有托架84，将托架保持钉匣体86，楔形滑轨驱动器88，缝钉驱动器90以及缝钉92。需要理解的是，楔板驱动器88在位于匣托架84与匣体86之间的发射槽94(图2)内纵向运动。该楔板驱动器88呈凸轮状表面，该表面与缝钉驱动器90相接触并使其向上升起，从钉孔96(图3)向上驱动缝钉92，使其与砧座14的缝钉形成凹槽98(图3)接触，形成“B”形缝钉，例如图6中的附图标记100处所表示的。特别参考图3，钉匣体86还包括近侧开口，垂直狭缝102，用于E形梁80通过。特别地，沿E形梁80的远端设置切割表面104，以在组织吻合之后将切割组织。
在图2，5，6中，端部执行器12分别按照开放(即，初始)状态、夹紧和未发射状态以及完全发射状态的顺序被描绘出。特别描述了E形梁80便于端部执行器12的发射的特征。在图2中，该楔板驱动器88完全处于近侧位置，表明未发射钉匣82。对准中间销106以进入钉匣82的发射槽94，用于向远侧驱动楔板驱动器88。E形梁80的底部销或帽108沿细长通道16的底面滑动，因此该中间销106及底部销108与细长通道16滑动地接合。在图2的开放及非发射状态下，E形梁80的顶部销110已进入并位于砧座14的砧座袋112内，因而不会阻碍砧座14的反复开启和闭合。
在图5中描绘出的端部执行器12夹紧并准备发射。该E形梁80的顶部销110与砧座14的砧座狭缝114对准，该砧座狭缝位于砧座袋112远侧并与之连接。在图6中，E形梁80已完全发射，并且上部销110在砧座狭缝114下平移，从而当切割表面104切割被加紧的组织时确定地将砧座14与细长通道16间隔开。同时，中间销106已如前所述地致动筒82。之后，E形梁80在开启端部执行器12及重置钉匣82之前被退回，以用于其它操作。
示例性的端部执行器12在五篇未审结和共同拥有的美国专利申请中有更详细地描述，每一篇所公开的全部内容在这里被引入作为参考：(1)“具有用于防止发射的单个闭锁机构的外科吻合器械”，其序列号为No.10/441,424，由Frederick E.Shelton IV，Michael Setser，Bruce Weisenburgh II于2003年6月20日提交；(2)“具有分开的不同的闭合及发射系统的外科吻合器械”，序列号为No.10/441,632，由Frederick E.Shelton IV，Michael Setser，Brian J.Hemmelgarn II于2003年6月20日提交；(3)“具有耗尽匣闭锁的外科吻合器械”，序列号为No.10/441,565，由Frederick E.Shelton IV，Micheal Setser，BruceWeisenburgh II于2003年6月20日提交；(4)“具有用于未闭合砧座的发射闭锁的外科吻合器械”，序列号为No.10/441,580，由Frederick E.Shelton IV，Michael Setser，Bruce Weisenburgh II于2003年6月20日提交；以及(5)“结合有E形梁发射机构的外科吻合器械”，序列号为No.10/443,617，由Frederick E.Shelton IV，Michael Setser，BruceWeisenburgh II于2003年6月20日提交。
需要理解的是，虽然在这里示出的是无铰接轴18，但本发明的应用可包括能铰接的器械，例如五篇未审结和共同拥有的美国专利申请中所描述的那样，其中每一篇所公开的全部内容在这里被引入作为参考：(1)“结合有具有围绕纵向轴线旋转的铰链机构的外科器械”，序列号为No.10/615,973，由Frederick E.Shelton IV，Brian J.Hemmelgarn，Jeffrey S.Swayze，Kenneth S.Wales于2003年7月9日提交；(2)“结合有用于发射杆轨道的铰接接头的外科吻合器械”，序列号为No.10/615,962，由Brian J.Hemmelgarn于2003年7月9日提交；(3)“带有横向运动铰链控制的外科器械”，序列号为No.10/615972，由Jeffrey S.Swayze于2003年7月9日提交；(4)“结合有用于增加铰接接头周围弹性的锥形发射杆的外科吻合器械”，序列号为No.10/615,974，由Frederick E.Shelton IV，Michael Setser，Bruce Weisenburgh II于2003年7月9日提交；以及(5)“具有用于支撑发射杆的铰接接头支撑板的外科吻合器械”，序列号为No.10/615,971，由Jeffrey S.Swayze，Joseph Charles Hueil于2003年7月9日提交。
多冲程发射手柄
图7-8详细示出了外科吻合和切割器械10的手柄部20，图示了链接传输发射机构150，其提供了一些特征，例如增加的强度，减小的手柄尺寸，最小的束缚等等。
端部执行器12(未示于图7-8)的闭合是由朝向手柄20的手枪式握把36压下闭合触发器26而引起的。该闭合触发器26绕联接于由右和左半壳体156、158(后者示于图15-18)构成的手柄外壳154上的闭合触发器销152转动，从而使闭合触发器26的上部160向前运动。闭合管24通过闭合轭形件162接收这一闭合运动，该闭合轭形件通过闭合轭形件销166和闭合连杆销168分别销接在闭合连杆164上以及闭合触发器26的上部160上。
在图7的完全开启位置中，闭合触发器26的上部160接触并在所示的位置处保持枢转闭合解除按钮38的锁定臂172。当闭合触发器26到达完全压下位置时，该闭合触发器26解除锁定臂172，并且抵接表面170旋转或与枢转锁定臂172的在远侧朝右的凹口171接合，从而将闭合触发器26保持在这一夹紧或闭合位置。锁定臂172的近端与手柄外壳154绕横向枢转连接件174旋转，从而露出闭合解除按钮38。闭合解除按钮38的中远侧178被压缩弹簧180向近侧推压，该压缩弹簧在外壳结构件182与闭合解除按钮38之间受压。结果。闭合解除按钮38以逆时针方向(当从左边看时)将锁定臂172推动成与闭合触发器26的抵接表面170锁定接触，这可防止闭合触发器26在链接传输发射系统150处于未退回状态时不夹紧，后面将详细进行描述。
在闭合触发器26退回并被完全压下的情况下，发射触发器34解锁并可以朝向手枪式握把36多次压下，以进行端部执行器12的发射。像描述的那样，链接传输发射机构150通过组合拉/压弹簧184被第一次退回、并被推压以保持在该位置，该弹簧184被限制在手柄20的手枪式握把36内，其不动的端部186与手柄外壳154连接，且可动端部188与钢带192的向下挠曲的近侧退回端部190相连接。
刚带192的置于远侧的端部194与链接联接件195连接，用于结构加载，其依次与形成链接齿条200的多个连杆196a-196d的前部连杆196a连接。链接齿条200是弹性的，但其具有远侧连杆，这些连杆形成直的刚性齿条组件，该组件可通过执行部分22内的发射杆32传输相当大的发射力，且易于退回到手枪式握把36内，从而使手柄20的纵向长度最小化。
需要理解的是，相对于单根弹簧，组合拉/压弹簧184增加了可用的击发行程的大小，同时基本上减小了最小长度的一半。
发射触发器34绕发射触发器销202枢转，该发射触发器销与手柄外壳154相连。当发射触发器34朝手枪式握把36压下时，发射触发器34的上部204绕发射触发器销202向远侧运动，从而拉伸在近侧连接在发射触发器34的上部204与手柄外壳154之间的近侧放置的发射触发器拉伸弹簧206。发射触发器34的上部204在每次发射触发下压期间通过牵引偏压机构210与链接齿条200接合，且当发射触发器34解除时该牵引偏压机构210也断开接合。发射触发器拉伸弹簧206在被松开并与牵引偏压机构210脱离接合时向远侧推动发射触发器34。
在链接传输机构150致动时，惰轮220通过与链接齿条200的带齿上表面222接合而沿顺时针方向旋转(从左侧看时)。这一旋转被联接到指示齿轮230上，该指示齿轮因而响应于惰轮220做逆时针旋转。惰轮220和指示齿轮230都可旋转地连接到手柄外壳154上。可有利地选择链接齿条200、惰轮220以及指示齿轮230之间的传动关系，从而使带齿上表面222具有如下的齿尺寸，即，有适当的强度并且指示齿轮230在链接传输发射机构150整个击发行程期间不会作出超过一次的旋转。
如下面将更详细描述的那样，指示齿轮230执行至少四项功能。第一，当链接齿条200完全退回且触发器26、34都如图7那样张开时，将指示齿轮230的左侧上的环形凸脊242内的开口240呈现给锁定臂172的上表面244。锁定臂172通过与闭合触发器26的接触被偏压进开口240中，该闭合触发器262被闭合拉伸弹簧246推压到张开位置。闭合触发器拉伸弹簧246在近侧与闭合触发器26的上部160及手柄外壳154连接，因此在闭合触发器26闭合期间具有储存的能量，能将闭合触发器26向远侧推动至其未闭合的位置。
其次，与从外部置于手柄20上的指示退回旋钮40连接的指示齿轮230将发射机构150的相对位置传递给指示退回旋钮40，从而使外科医生获得还需要发射触发器34的多少冲程可完成发射的可视指示。
第三，指示齿轮230在操作外科吻合和切割器械10时可使防倒转机构(单向离合器机构)250的防倒转解除杆248沿纵向及角运动。在发射冲程期间，防倒转解除机构248由指示齿轮230引起的向近侧的运动激发防倒转机构250(图15-16)，该机构250允许发射杆32向远侧运动并防止发射杆32向近侧运动。这一运动也使得防倒转解除按钮42从手柄外壳154的近端延伸，以便在发射冲程期间需要退回链接传输发射机构150时由操作者致动。在发射冲程完成之后，指示齿轮230当发射机构150退回时反向旋转。该反向旋转解除防倒转机构250的作用，将防倒转解除按钮42收回到手柄20内，并将防倒转解除杆248沿横向旋转至右侧(图19)，从而允许指示齿轮230继续反向旋转。
第四，指示齿轮230接收来自指示退回旋钮40的手动旋转(在图7中为顺时针)，以将发射机构150退回，并且防倒转机构250解锁，由此克服发射机构150内的不易由组合拉/压弹簧184克服的任何束缚。这一手动退回辅助可在发射机构150的否则将由防倒转机构250防止的部分发射之后应用，防倒转机构250可退回防倒转解除按钮42，从而后者将不会沿横向运动防倒转解除杆248。
在图7-8中，防倒转机构250包括操作者可接近的防倒转解除杆248，其在近端可操作地与防倒转解除按钮42联接，且其在远端可操作地与防倒转轭256联接。特别地，防倒转解除杆248的远端254通过防倒转轭形件销258与防倒转轭256接合。该防倒转轭256沿纵向运动，以向防倒转凸轮槽管252施加旋转，该防倒转凸轮槽管252受手柄外壳154的纵向限制且从发射杆32与链接齿条200的连杆联接件195的连接处的远侧包绕发射杆32。该防倒转轭256通过凸轮槽管销260将来自防倒转解除杆248的纵向运动传递到防倒转凸轮槽管252。即，防倒转凸轮槽管252内的成角度的狭缝内的凸轮槽管销260的纵向运动使防倒转凸轮槽管252旋转。
夹在框架28的近端与防倒转凸轮槽管252之间的分别是防倒转压缩弹簧264、防倒转盘266、以及防倒转凸轮管268。如描述的那样，发射杆32向近侧的运动致使防倒转盘266从顶部向后枢转，提供与发射杆32的增加的摩擦接触，这阻挡发射杆32进一步向近侧运动。
当防倒转凸轮槽管252与防倒转凸轮管268间隔很小时，该防倒转盘266以类似于保持纱门打开状态的纱门锁的枢转方式枢转。特别地，防倒转压缩弹簧264能作用于盘266的顶面，以将防倒转盘266倾斜到其锁定位置。防倒转凸轮槽管252的旋转导致防倒转凸轮管268的向远侧的凸轮运动，由此向远侧压迫防倒转盘266的顶部，克服来自防倒转压缩弹簧264的力，因此将防倒转盘266定位在未倾斜(垂直)、未锁定的位置上，在该位置上允许发射杆32向近侧退回。
特别参考图8-10，牵引偏压机构210被描述为由棘爪270构成，该棘爪具有向远侧凸出的狭窄尖端272以及在其近端处向右凸出的横向销274(图8)，该横向销可旋转地插入穿过发射触发器34的上部204内的孔276。在发射触发器34右侧，横向销274接收偏压构件，描述为偏压轮278。在发射触发器34前后平移时，该偏压轮278经过靠近手柄外壳154的右半壳体156的一段圆弧，越过在其行程的最远侧部分处一体地形成于右半壳体156内的偏压斜面280。偏压轮278可有利地由弹性摩擦材料制成，能逆时针旋转(当从左边看时)入棘爪270的横销274内，因此向下牵引偏压向远侧凸出的狭窄尖端272进入最近的连杆196a-d的倾斜中央轨道282，以与链接齿条200接合。当解除发射触发器34时，偏压轮278因此在相反方向上牵引偏压棘爪270，从而从链接齿条200的倾斜中央轨道282提升狭窄尖端272。为了确保高承载条件及接近棘爪270向远侧的整个行程情况下尖端272脱离接合，棘爪270的右侧跳进闭合轭形件162右侧上的向近侧向上面向的斜面284(图8)，以使狭窄尖端272与倾斜中央轨道282脱离接合。如果发射触发器34在除整个行程外的任何点上解除，偏压轮278被用于将狭窄尖端272从倾斜中央轨道282上升起。尽管描述了偏压轮278，需要理解的是，偏压构件或偏压轮278的形状被示例性的，并可改变以适应不同的形状，这些形状使用摩擦力或牵引力来接合端部执行器的发射或与其脱离接合。
特别参考图10，其中更加详细地描述了链接齿条200以示出许多优点。每一连杆196a-d与邻接的连杆196a-d通过销连接，用于向下、向近侧旋转进入手枪式握把36。虽然在该方向上可以弯曲，但链接齿条200在抵抗柱形载荷，特别是否则将推压远侧连杆196a-d向下弯曲时形成了刚性结构。特别地，每一连杆196a-d在近侧终止于外凸延伸部分300，该延伸部分在其下部具有横向通孔302。每一连杆196a-d的左侧304包括带齿的上表面222，并且右侧306平行于左侧304，在它们之间限定倾斜中央轨道282，该轨道终止于外凸延伸部分300。
中央轨道282的近侧部分终止于右侧304和左侧306之前，形成用于从前一连杆196a-d接收外凸延伸部分300的U形夹308，该连杆通过枢轴销310铰接连接。每个前一连杆196a-d在其近端具有平面312，该平面通常垂直于来自发射杆32的柱状载荷的方向。每个后一连杆196a-d在其远端具有接触面314，其也通常垂直于柱状载荷的方向。横向通孔302被充分隔开，以便在邻接的平面312的下部与接触面314的下部之间形成凹口316，以为后一连杆196a-d相对于前一连杆196a-d向下枢转提供了间隙。但是，由于前一和后一连杆196a-d沿纵向排列，邻接平面312的上部与接触面314的上部对准以便抵接，由此阻挡进一步的向上偏转。如图所示，当邻接连杆196a-d为水平时，孔302和销310定位于发射杆32的动作线之下。当向发射杆34施加载荷时，牵引偏压机构210沿动作线施加推压载荷并一起压连续的水平连杆196a-d。因此，向轴销310上施加发射力的作用线将保持任一前一连杆196a-d处于刚性平直构造。后一连杆196b-d的倾斜中央轨道282引导棘爪270的向远侧狭窄尖端272与前一连杆196a-c的外凸延伸部分300接合。
前一连杆196a的在远侧连接到连杆联接件195，该联接杆195包括联接于发射杆32近端的部件，还包括类似于连杆196a-d的外凸延伸部分300以及平面312，并且在刚带192的置于远侧的端部194的小凸起320、322(图8)之间有充分的间隔接收它，其中小凸起320、322通过与将连杆196a连接到连杆联接件195的枢转销相同的轴销310连接。在这一力上施加退回力可通过沿发射杆32的纵向轴线和链接齿条200的平直部分施加该力而有利地减少摩擦力。
与倾斜中央轨道282不同，在左侧304上具有带齿上表面222，这允许棘爪270和链接齿条200之间不带束缚的、强有力的接合，即使发射触发器34以变化的运动范围受到冲击。同时，带齿上表面222提供与惰轮220的连续啮合，以获得上述优点。
需要理解的是，虽然已有利地描述了连杆196a-d之间的通过销连接的U形夹连接件的优点，但也可使用弹性或挠性连接件。另外，描述了四个连杆196a-d，但可根据击发行程、曲率半径等可选择连杆的不同数量和长度。
牵引偏压机构
图11-14中的链接传输发射机构150是以如下顺序描绘的，即，解释牵引偏压机构210(即，棘爪270，偏压轮278以及偏压斜面280)如何确定地响应发射触发器34的行程的方向。此外，由于偏压轮278与偏压斜面280摩擦接触，当棘爪270完成完全的断开或接合运动时偏压轮278滑动。
在图11中，发射触发器34已部分地下压到牵引偏压机构210开始将发射触发器34的运动啮合到链接齿条200上的位置。特别地，偏压轮278已经与偏压斜面280的近端相接触，因此开始逆时针旋转(从左边看时)，将这一旋转施加给初始地与链接齿条200脱离接合的棘爪270。在图12中，发射机构150已充分前进了一段距离，以使棘爪270可完全旋转或与第一连杆196a的倾斜中央轨道282啮合，抵接连杆联接件195并由此将发射运动传递给发射杆32。在图13中，发射触发器34和整个发射机构150已经继续前进到接近整个行程的位置，在这一运动期间，偏压轮278已经沿偏压斜面280滑动。在发射冲程的最后，棘爪270(图8)的右下边缘与闭合轭形件162的面向近侧向上的斜面284接触，并且将棘爪270从与连杆196a-d的啮合中提升，从而允许链接齿条200退回。
在图14中，发射触发器34已为偏压轮278充分解除来获得偏压斜面280上向近侧的牵引力，从而导致顺时针旋转(从左边看时)，并提升棘爪270。当给定链接齿条200的倾斜中央轨道282的向近侧指向的斜坡时，发射机构150在准备另一发射冲程或退回周期的向近侧的运动过程中不会受到阻碍。
需要理解的是，牵引偏压机构210可在能执行至少一个单个冲程的器械中实施。
防倒转机构
如上所述，防倒转机构250在发射冲程期间锁定以防止发射杆32以及因此防止该发射机构150退回，直到完成整个发射的行程或使用者选择退回。在图15中，该发阻塞机构250处于锁定状态。该防倒转解除杆248处于最近侧位置，并且已将防倒转凸轮槽管252旋转成与防倒转凸轮管268啮合，从而形成最小的纵向长度，产生用于防倒转盘266的增加的空间。如图16所示，防倒转盘266通过防倒转压缩弹簧264以示出的角度倾斜回并抓住发射杆32。
在图16中，框架28的近端400包括半个卷筒部分402，其接收防倒转压缩弹簧264并使之抵靠在其远端的环形圈404上。在靠近弹簧264处，框架28具有顶部的向近侧开口的槽406，该槽与框架28的内部连通。该防倒转盘266大致为平面盘，其形状适于装配开口槽406中与弹簧264邻近。通孔408穿过盘266延伸。特别地，从开口槽406上露出的防倒转盘266的顶部向上凸出，以接收来自弹簧264的力。防倒转盘266的下部沿纵向受到限制，并且不与弹簧264接触。因此，除非受到防倒转凸轮管268的限制，防倒转盘266的顶部被推压成向近侧倾斜，从而导致防倒转盘266内的通孔408束缚发射杆32。
在图17中，防倒转机构250是解锁的。该反锁解除杆248已沿横向运动到右侧，向防倒转轭256的右侧施加运动，由此带动防倒转凸轮槽管252的顺时针旋转(从近端看时)。防倒转凸轮槽管252的凸轮表面410与防倒转凸轮管268内的近侧切口412分开，迫使后者抵抗防倒转盘266向近侧运动，该防倒转盘又运动至垂直的解锁位置，并进一步压缩防倒转压缩弹簧264。
在图18中描述了在发射触发器34已经被击发两次之后在防倒转解除杆248和指示齿轮230右侧之间的相互作用。杆开口420穿过防倒转解除杆248延伸，以接收并与弯曲面430相互作用，该弯曲面从指示齿轮230的右侧向外延伸。指示齿轮230的旋转向远侧驱动防倒转解除杆248，使防倒转解除按钮42降至最低点进入按钮接收孔422内，并与防倒转机构250脱开，并将其向近侧驱动，这就如示出的暴露出防倒转解除按钮42，也将防倒转解除杆248弹到右侧以致动防倒转机构250(图19)。该防倒转轭256作采用带有防倒转轭形件销258(未示出)的沿纵向切槽的连接件允许该运动。弯曲面430环绕指示销432的接近四分之一圆周，指示齿轮230围绕该指示销转动。弯曲面430的最右侧部分(当从右边看时)或峰部434远离指示齿轮230的表面向右凸出最远。弯曲面430的最左侧部分或入口436因此与指示齿轮230的表面齐平。
在图20-25中，杆开口420被形成为带有水平狭槽440的形状，该狭槽限定防倒转解除杆248可进行的向近侧和远侧的运动，并且指示齿轮432位于这一水平狭槽440内。顶部凹槽442及底部凹槽444垂直加宽并与水平狭槽440连通，并且限定在弯曲面430的最左侧部分434沿纵向平移防倒转解除杆248的角位置。顶部和底部凹槽442、444的尺寸允许弯曲面430进入相应的凹槽442，444而不会倾斜防倒转解除杆248，直到正常发射的结束。该杆开口420位于防倒转机构250的纵向轴线上方，并因此向右的力产生防倒转凸轮槽管252的旋转力。
在图20中，防倒转解除杆248与指示齿轮230处于其初始状态并且它们闭合触发器26被致动期间始终保持如此。特别地，该防倒转解除杆248被向远侧定位，将防倒转解除按钮42降到最低点进入按钮接收孔422内。弯曲面430位于其最左侧的极限位置(从右边看时)，并且其峰部434在大致6点钟的位置附近处于杆凹槽420的下凹槽444的近侧垂直表面的远侧，并且弯曲面430的入口436位于3点钟的位置。
在图21中，发射触发器34(未示于图20-25)的第一发射冲程已发生，其中峰部424已作用于底部凹槽444的近侧垂直表面，且弯曲面430已顺时针旋转至约9点钟的位置。因此，防倒转解除杆248已向近侧平移，以从按钮接收孔422露出防倒转解除按钮42，并致动防倒转机构250。如此选择指示齿轮230的顺时针旋转与完整发射冲程的期望数量之间的比率关系，即，弯曲面430在进行后续的发射冲程时继续不受到阻碍，如图22中所示，其中已完成两个发射冲程，峰部被运动至大致12点钟的位置。因此，峰部434的在上部凹槽442的远侧垂直边缘的近侧并与之邻接，如此定位以便后续的发射冲程将作用在防倒转解除杆248上，从而引发向远侧的水平运动。注意，在这些发射冲程期间，弯曲面430位于指示齿轮432的近侧。按压解除按钮42将导致杆开口420的近侧边缘跨入弯曲面430内，使防倒转解除杆248如图19那样倾斜。
在图23中，最后的发射冲程正在结束，在此期间峰部434已经运动到接近3点钟的位置，与此同时，将水平狭槽440的近端抵靠指示销432向上运动，将防倒转解除按钮42降到最低，解除防倒转机构250并由此启动链接传输发射机构150的退回。
在图24中，解锁的防倒转机构250已允许链接齿条200在弹簧力的作用下退回，这又导致指示齿轮230的逆时针旋转(从右边看时)。当发射机构150开始退回时，指示齿轮230的逆时针旋转将弯曲面430的有角度的表面滑动成与顶部凹槽442的近侧边缘倾斜接触。指示齿轮230的继续旋转驱动防倒转解除杆248的上部下面的弯曲面430并使杆248倾斜或偏转至图19中所示的位置。防倒转解除杆248的倾斜运动在链接齿条200退回期间由弯曲面430提供以防止杆248的纵向运动。在防倒转机构250在发射序列结束时自动解锁之后，如果链接齿条200在最后冲程结束时不会退回，转动连接于指示销432的指示按钮40(未示于图20-25)将提供额外的力来退回链接齿条200。还需要理解的是，在发射机构150的部分发射期间，例如图22中所示那样，按压解除按钮42也将通过向远侧运动防倒转解除杆248来使防倒转机构250解锁而退回链接齿条200。该退回动作一直持续到指示齿轮230返回至其初始位置，如图25所示。
需要理解的是，杆开口420的形状及拱面430的拱形尺寸被示出，但也可进行改变来适应因不同发射冲程数量而构建的手柄。
需要注意的是，由指示齿轮230和杆开口420的相互作用形成的旋转解除机构也可被替换为其他的连杆机构。
开口闭锁
在图26中，外科吻合及切割器械10处于其初始开启状态，并且闭合及发射触发器26，34都朝前且链接齿条200退回。如上所述，在该未发射状态下，指示齿轮230向锁定臂172的上表面244提供其在环形凸脊242的开口，锁定臂通常在外壳结构件182和闭合解除按钮38的中远侧178之间的压缩弹簧180的作用下向下旋转出开口240之外。在图26中，闭合解除按钮38已经被按下，致使上表面244进入开口240。在图27中，闭合触发器26和锁定臂172在相对手枪式握把36压下闭合触发器26后处于夹紧抵接状态，且发射触发器34摆入发射位置。该闭合解除按钮38如所注意到的通过展开的闭合弹簧180而没有被压下。锁定臂172的上表面244摆动到环形凸脊242下面，且指示齿轮230解锁并可自由地逆时针旋转。锁定臂172的向下运动解锁指示齿轮230及链接传输发射机构150，并允许击发发射触发器34。因此，当指示齿轮230随着后来的发射继续旋转时，阻止了闭合解除按钮38解除夹紧的闭合触发器26。
定位指示器和解除机构
在图28中，外科吻合和切割器械610用可选的指示装置640替换了指示器退回旋钮，该指示装置向上延伸以提供顶部可达的退回杆642，该杆用作阻塞发射退回器，其可容易地由任一只手击发。该器械610是张开的并且未发射，像由远侧向前的闭合和发射触发器26、34及该开的端部执行器12所指示的那样。当发射没有开始时，退回杆642通常向远侧旋转邻接于手柄外壳154。该指示器640可联接(未示出)于前面描述的惰轮220和发射机构150，如前面所述的那样，其中退回杆642在连杆传输机构150被发射时向近侧旋转，提供发射的可视指示，并通过向其施加手动的向远侧的力以允许辅助自动退回的方式作为一种旋转定位指示器。旋转的方向必须是相反的，这样其必须为这一可视的目的与惰轮220连接。
在图29中，另一可选的发射机构650结合了前述的顶部可达退回杆642及指示装置640，该指示装置联接于具有在带齿区域668内的第一和第二延长(olwell)区域662、664的指示齿轮660。当退回杆642位于其远侧位置与手柄外壳154邻接时，将该第一停留区域662提供给惰轮220。因此，惰轮220可自由地通过纵向运动链接齿条200的驱动顺时针旋转及逆时针旋转。如果E形梁80(未示于图29)出于任何原因阻塞在端部执行器12内，且不能被组合拉/压弹簧184(未示于图29)向近侧退回，该退回杆642可由外科医生向近侧拖动来使指示齿轮660顺时针旋转(从左边看时)。退回杆642的旋转运动使指示齿轮660旋转，并使第一和第二停留区域662、664之间的曲面齿段670与惰轮220的齿相接触，从而可操作地将退回杆642联接于发射机构650上。
一旦联接，外科医生就可将额外的力施加到退回杆642上，以将发射机构650退回，由此逆时针旋转惰轮220及沿纵向向近侧运动链接齿条200，以退回E形梁80。当退回杆642进一步旋转到图30中的位置时，惰轮220与曲面齿段670脱离接合并通过第二停留区域664从退回杆642上脱开。在这一点上，力的应用使阻塞的发射机构650自由，且组合拉/压弹簧184将使链接齿条200完全退回。
一种可选的设计方案(未示出)包含了增加的在退回杆642与指示齿轮660间的单向滑动离合，例如Sprague离合器或等同物(未示出)。在前面的设计中，退回杆642的运动范围受在该范围的每一端点或小于完全旋转的运动处与手柄外壳154接触的限制。这就限制了退回杆642的一次运动能退回发射系统650的距离。在退回杆642与指示齿轮660之间增加的单向滑动离合器当退回杆642转回(由远及近)时，允许退回杆642可操作地与指示齿轮660啮合，且当杆642向前运动(由近及远)时脱离接合。这就通过多次拖动退回杆642确保发射机构650的完全退回。第二停留区域664可从指示齿轮660上去除，以确定更多的齿到齿的啮合。此外，结合离合器机构允许退回杆在使用后旋转成邻接手柄20。
在使用中，外科医生通过套管或套管针将端部执行器12及轴18定位在手术部位上，并将砧座14和细长通道16作为相对的钳口定位，以抓握待吻合及切割的组织。一旦对端部执行器12的位置满意，闭合触发器26就朝向手柄20的手枪式握把36按压，从而使闭合触发器26的上部160锁在枢转地连接于闭合解除按钮38上的锁定臂172上。然后，发射触发器34被按下和解除一预定时间，以执行整个击发行程，从而驱动发射杆降下轴18至端部执行器12的E形梁80。在发射期间，防倒转机构250处于锁定状态，防倒转盘266允许往回倾斜，从而束缚发射杆32的任何向近侧的运动。该远侧发射运动由包括近侧地连接到发射杆32上的链接齿条200的链接传输发射机构150给予发射杆32，其中每一连杆196a-d通过销连接在附近的连杆196a-d上，从而允许手枪式握把36向下弯曲但不能向上弯曲，当力直接作用于连杆196a-d之间的枢轴销310上方时形成了刚性结构。特别地，联接到发射触发器34上的牵引偏压机构210包含与手柄外壳154摩擦地联接的偏压轮278耦合，从而远侧发射运动给予棘爪270接合偏压，推动棘爪与链接齿条200啮合。在冲程结束时，棘爪270通过与闭合轭形件162的斜面284接触而从与连杆196a-d的发射啮合中抬起。发射机构150的返回运动致使偏压轮278给予棘爪270反偏压，从而保持棘爪270在链接齿条200上方，由此由防倒转机构250保持在适当的位置。在最大击发行程时，指示器传动机构230包括弯曲面430，该弯曲面脱扣防倒转解除杆248，该防倒转解除杆向防倒转盘266施加力使其进入解锁状态，从而允许链接齿条200进行而允许射杆32被存储于组合拉/压弹簧184中的压缩力收回。因此，链接齿条200被收回手枪式握把36中。可选择的是，在发射冲程期间，外科医生可按下防倒转解除按钮42，从而引发防阻塞解除杆248的倾斜。指示器旋钮40可有利地使外科医生知道发射已经进行了多远并辅助退回已遭遇束缚的E形梁80。
在最大击发行程束时带有自动退回的连接发射传输
在图31-32中，外科吻合和切割器械1010包括在多冲程击发行程结束时的自动刀退回。上述的优点仍为端部执行器保留，该端部执行器在示例的形式中是缝钉施加装置1012。特别参考图31，砧座1014可被可重复地绕其枢转连接件打开和闭合成细长(缝钉)通道1016。该缝钉施加组件1012近侧地连接于细长轴1018上，形成了执行部分1022。当钉施加组件1012闭合时，执行部分1022具有小的横截面积，其适于通过外部连接和操纵的手柄1020穿过套管针插入。
手柄1020安装在使用者控制的手柄外壳1154上，例如旋转旋钮1030，其使细长轴1018和钉施加组件1012围绕轴1018的纵向轴线旋转。按下闭合触发器1026来闭合钉施加组件1012，该闭合触发器在手枪式握把36前面绕穿过手柄外壳1154横向地啮合的闭合触发器销1152枢转。在闭合触发器1026前面枢转的多冲程发射触发器1034使钉施加组件1012同时切割并吻合夹在其中的组织。由于使用多发射冲程来减少外科医生的手在每一次冲程所需的力的大小，右和左指示器齿轮1040，1041(前面在图33中描述过)旋转，产生了发射进程的指示。例如，最大击发行程可需要三个完全的发射冲程，并因此指示器齿轮1040，1041在每次冲程时向上旋转三分之一圈。如果需要的话，手动发射解除杆1042允许在最大击发行程之前退回，并允许在出现了束缚或退回偏压失败时有助于退回。当闭合触发器1026被夹住时闭合解除按钮1038向外，并且部分发射没有发生，这会防止松开闭合触发器1026。
参考图31-33，细长轴1018具有纵向往复闭合管1024作为其外部结构，该闭合管装使砧座1014上枢转，以执行响应于手柄1020的闭合触发器1026的近侧按压的闭合。该细长通道1018通过闭合管1024内部的框架1028(图33)连接于手柄1020上。该框架1028与手柄1020可旋转地啮合，从而扭转旋转旋钮1030(图33)引发执行部分1022的旋转。特别参考图33，旋转旋钮1030的每个半壳体包括向内的凸起1031，其进入闭合管1024内相应的较长侧开口1070，并向内与框架1028(图31-33中未示出)啮合，这确定了执行部分1022的旋转位置。较长开口1070的纵向长度足够长，以允许闭合管1024的纵向闭合运动。
闭合触发器1026的上部1160通过闭合连杆1164向前推动闭合轭形件1162。闭合连杆1164在其远端通过闭合轭形件销1166与闭合轭形件1162轴接，并且在其近端通过闭合连杆销1168枢轴连接。闭合触发器1026由闭合触发器拉伸弹簧1246推动至打开位置，该弹簧近侧地连接于闭合触发器1026的上部1160及由右和左半壳体1156，1158形成的手柄外壳1154上。
闭合触发器1026的上部1160包括具有后槽1171的近侧顶部1170。该闭合解除按钮1038和枢转锁定臂1172通过中央横向枢轴1173连接。压缩弹簧1174将闭合解除按钮1038向近侧偏压(从右边看时绕中央横向枢轴1173顺时针)，在闭合触发器1026如图34-35那样被解除而上部1160返回时，枢转锁定臂1172靠在近侧顶部1170上，在闭合解除按钮1038中拉动。当闭合触发器1026到达其完全按压位置时，应当理解的是，后槽1171出现在枢转锁定臂1172下方，在压缩弹簧1174的推动下枢转锁定臂落入后槽1171内并在其上锁定。随着发射构件退回，闭合解除按钮1038的手动按压使枢转锁定臂1172向上旋转，从而松开闭合触发器1026。
一旦闭合触发器1026被近端地夹紧，响应于多冲程发射触发器1034被拖进手枪式握把1036内(其中在右和左指示器轮1040，1041上发射运动的数量对外科医生可见)，发射杆1032从手柄1020向远侧运动。发射触发器1034绕发射触发器销1202枢转，该发射触发器销横向穿过右和左壳体1156，1158并与其啮合。
链接传输发射机构1150被初始地退回，由限制在手柄1020的手枪式握把1036内的组合拉/压弹簧1184保持在该位置，其固定端1186连接于外壳1154上，并且运动端1188连接于钢带1192的向下弯曲的近侧的退回端1190上。
钢带1192的远侧放置的端部连接于形成链接齿条1200的多个连杆1196a-1196d中的前连杆1196a上的连接结构1195上。链接齿条1200是柔性的，而且具有形成直线刚性齿条组件的远侧连杆，其可将很大的发射力通过执行部分1022的发射杆1032传输，而且容易地退回至手枪式握把1036中，以使手柄1022的纵向长度最小化。应当理解的是，组合拉/压弹簧1184增加了可使用的击发行程的数量，同时在单根弹簧上将最小长度基本上减少一半。
防倒转机构
在图33，35中，防倒转机构1250防止结合拉伸/压缩弹簧1184在发射冲程之间退回链接齿条1200。耦合滑动管1131与第一连杆1196a抵接并与发射杆1032连接，从而连通发射动作。该发射杆1032向近侧延伸出框架1028的近端，并穿过防倒转盘1266的通孔1408。该通孔1408的尺寸当垂直排列时适于滑动地接收发射杆1032，但当倾斜时束缚。下片连接件1271从框架1028的近端的下唇向近端延伸，延伸穿过防倒转盘1266的下缘上的孔1269。该下片连接件1271将防倒转盘1266的下部近侧地拉到框架1028，从而防倒转盘1266在发射杆1032向远侧推进时是垂直的，并在发射杆1032企图退回时允许倾斜顶部后端进入束缚状态。防倒转压缩弹簧1264受框架1028的近端的限制并且近侧地抵接防倒转盘1266的顶部，从而将防倒转盘1266偏压成锁定状态。
防倒转凸轮管1268在反抗弹簧的压力的同时滑动地包围联接滑动管1131并抵接防倒转盘1266。连接到防倒转凸轮管1268上的近侧凸出的防倒转轭形件1256延伸高出闭合轭形件1162。
链接齿条触发的自动退回
在图31-41中，连杆触发自动退回机构1289被结合到外科吻合和切割器械1010，以在最大击发行程结束时使刀退回。为此，远侧连杆1196d包括在远侧连杆1196d进入形成于闭合轭形件1162内的齿条通道1291时向上凸出的柄脚1290。该柄脚1290被排列成激励在防倒转解除杆1248(图40)上的底部近侧凸轮1292。特别参考图38-39，形成在右和左半壳体1156、1158内的结构限制了防倒转解除杆1248的运动。分别形成于右和左半壳体1156，1158之间的销接收孔1296和环形销1293通过形成于底部近侧凸轮1292远侧的防倒转解除杆1248内的细长孔1294收纳，从而允许纵向平移以及围绕环形销1293的旋转。在右半壳体1156中，近侧开口通道1295包括近侧水平部1295a，其与向上并远端地成角度的部分1295b连通，该成角度的部分收纳防倒转解除杆1248近端附近的向右的后销1297(图39)，因此当防倒转解除杆1248到达其平移的最远侧部分时赋予向上的旋转。一旦为了保持在近侧开口通道1295内的向右的后销1297而装配，形成于防倒转解除杆1248近侧的右半壳体1156内的阻塞结构件1333防止其向近侧运动。
如图39，40所示，防倒转解除杆1248的远端1254被向远侧且向下推动，从而引起向右的前销1298落入形成于右半壳体1156内的远侧开口阶梯结构件1299中，该右半壳体由勾在防倒转解除杆1248上的向左的钩131上的压缩弹簧1300(图40)推入该接合中，该防倒转解除杆位于向右的前销1298和纵向细长的孔1294之间。压缩弹簧1300的另一端在更近侧且更低的位置闭合轭形件1266的正上方连接到形成于右半壳体1156内的钩1302(图38，40-41)上。压缩弹簧1300因此向下和向后拉动防倒转解除杆1248的远端1254，这导致向右的前销1298向远侧前进时锁进远侧开口阶梯结构1299中。
因此，在图41中，一旦脱扣(tripped)，防倒转解除杆1248保持向前，垂直地保持防倒转盘1266，并因此允许链接齿条1200退回。当闭合轭形件1266在松开端部执行器1012随后退回时，闭合轭形件1266上的向上凸出的复位柄脚1303接触防倒转解除杆1248的底部远侧凸轮1305，由此将向右的前销1298升离远侧开口阶梯结构1299，从而防倒转解除压缩弹簧1264可将防倒转凸轮管1268和防倒转解除杆1248向近侧推动到它们的退回位置(图38)。
侧棘爪发射机构
在图31-41中，可选的外科吻合和切割器械1010以一种与图1-31中不同的方式将发射触发器1034联接到链接齿条1200上。特别参考图32-37，发射触发器1034绕连接于外壳1154上的发射触发器销1202枢转。当朝向手枪式握柄1036按压发射触发器1034时，其该发射触发器1034的上部1204绕发射触发器销1202向远侧运动，从而将近侧地放置的发射触发器拉紧弹簧1206(图33)伸出，该弹簧近侧地连接于发射触发器1034的上部1204与外壳1154之间。发射触发器1034的上部1024在通过弹簧偏压的侧棘爪机构1210的每次发射触发器按压期间与链接齿条200啮合，其在解除发射触发器1034时也断开啮合。
特别地，由近侧且向右地面对的斜面形成在每一连杆1196a-1196d内的倾斜右侧轨道1282由侧棘爪组件1285啮合。特别地，棘爪滑动件1270(图33，35)具有右和左下导向件1272，其分别在形成于齿条通道1291下方的闭合轭形件1266内的左轨道1274(图33中)和形成于平行于齿条通道1291并与齿条通道盖1277连接的闭合轭形件轨道1276内的右轨道1275中滑动，该齿条通道盖闭合棘爪滑动件1270行程远侧的闭合轭形件1266内的齿条通道1291的朝右的开口部分。在图33-34，37中，压缩弹簧1278连接于在闭合轭形件轨道1276上的顶部近侧位置上的钩1279和在棘爪滑动件1270的远侧右侧上的钩1280之间，这保持棘爪滑动件1270被向近端拉动成与发射触发器1034的上部1204接触。
特别参考图33，棘爪块1318位于绕垂直后销1320旋转的棘爪滑动件1270上，该后销穿过棘爪块1318的左近侧角和棘爪滑动件1270。弹出凹槽1322形成于块1318的顶表面的远侧部分上，以接收通过垂直销1326枢转地销接于其内的弹出块(kick-out block)1324，该垂直销的底部尖端延伸进入在棘爪滑动件1270的顶表面上的棘爪弹簧凹槽1328。在棘爪弹簧槽1328内的棘爪弹簧1330延伸至垂直前销1326的右侧，当从上方看时，推动棘爪块1318逆时针旋转成与倾斜的右侧轨道1282接合。从上方看时，弹出块槽1322内的小螺旋弹簧1332推动弹出块1324顺时针旋转，从而推动其近端与形成于在齿条通道1291上方的闭合轭形件1266内的轮廓缘1334接触。
如图36所示，棘爪弹簧1330相对于小螺旋弹簧1332的较强机械优点意味着棘爪块1318倾向于与顺时针旋转的弹出块1324的接合。在图37中，当发射触发器1034被完全按压且开始被释放时，弹出块1324在棘爪滑动件1270退回时遇到轮廓缘1334内的凸脊1336，从而给弹出块1324施加作用力使其从上部看时做顺时针旋转，且由将棘爪块1318此从与链接齿条1200的啮合中踢出。弹出块凹槽1322的形状将弹出块1324的顺时针旋转停止成与轮廓缘1334垂直的方向，在完全退回期间保持该脱开，并由此因而消除了齿合噪音。多冲程发射机构的手动退回
在图33、35、42-47中，外科吻合和切割器械1010的第二形式包括可选的手动退回机构1500，其提供了发射位置指示、发射机构的手动解除、手动退回，以及在一种形式(图48-54)中进一步在最大击发行程结束时进行自动退回。在图33，42-43中，特别地，齿轮机构1502也起可视地指示击发行程的进程并手动退回刀的作用。前惰轮1220啮合链接齿条1200(图33，44-46)的齿状上部左表面1222。前惰轮1220还啮合了具有较小右侧棘轮1231的后惰轮1230。前惰轮1220和后惰轮1230分别在前惰轮轴1232和后惰轮轴1234上都可旋转地连接到手柄外壳1154上。后轮轴1232的每一端延伸通过相应的右和左外壳半壳体1156，1158，并连接到左和右指示器轮1040，1041上。由于后轮轴1234在手柄外壳1154内旋转并与后齿轮1230有键啮合，指示器轮1040，1041随后齿轮1230旋转。可以方便地选择链接齿条1200，惰轮1220以及后齿轮1230之间的齿轮关系，从而齿状上表面1222具有适当强的齿尺寸，并且在链接传输发射机构1150的整个击发行程期间后齿轮1230的旋转不超过一周。
后惰轮1230的较小右侧棘轮1231延伸进入手动退回杆1024的毂1506中，特别地与垂直纵向排列的槽1508(图42)对齐，将毂1506二等分。毂1506的横向通孔1510与上凹槽1512连通。前部1514的形状适于接收近侧定向的锁定棘爪1516，该锁定棘爪绕形成于上凹槽1512远端内的向后的横向销1518枢转。后部1520的形状适于接收L状的弹簧凸起1522，该凸起推动锁定棘爪1516向下与右侧较小的棘轮1231啮合。阻挡(hold up)结构件1524(图38，45)从右半壳体1156凸出进入上凹槽1512，从而当手动退回杆1042落下时(图45)阻止锁定棘爪1516与较小右侧棘轮1231啮合。螺旋弹簧1525(图33)推动手动退回杆1042下落。
在使用中，如图44-45中所示，组合拉/压弹簧1184可从与远侧定位的链接齿条断开。在图46-47中，当手动退回杆1042被抬起时，锁定棘爪1516顺时针旋转并不再受阻挡结构1524的阻挡，并与较小右侧棘轮1231啮合，从而当从左边看时使后惰轮1230顺时针旋转。因此，向前的惰轮1220逆时针响应退回链接齿条1200。另外，向右的弯曲凸脊1530从毂1506上凸出，其大小适于与防倒转解除杆1248接触并使其向远侧运动，以在旋转手动退回杆1042时解除防倒转机构1250。
凸轮自动退回
在图48-54中，用于外科吻合及切割器械1010a的可选自动退回机构1600在最大击发行程结束时将自动退回结合进惰轮1220a，该惰轮具有齿1602，其在凸轮1606中的环形沟槽1604内运动，直到在对应于三次发射冲程的近似完全旋转之后遇到挡块1608。向右的凸脊1610向上旋转成与底部凸轮凹槽1612接触，以向远侧移动防倒转解除杆1248a。
特别参考图49，可选的防倒转解除杆1248a包括如前所述地操作的远端1254。该环形销1293和形成在右和左半壳体1156，1158之间的销接收孔1296通过形成于底部凸轮1192后部的防倒转解除杆1248a内的通常为矩形的孔1294a被接收，从而允许纵向平移以及可选防倒转解除杆1248a的远端1254向下的锁定动作。在右半壳体1156内，水平近侧开口的通道1295a接收防倒转解除杆1248a近端附近的向右的后销1297。
在操作中，在图50，50A的发射之前，链接齿条200被退回并且防倒转凸轮管1268被退回，从而当防倒转压缩弹簧1264向近侧使防倒转盘1266倾斜时锁定防倒转机构1250。可选的自动退回机构1600处于原始状态，此时防倒转解除杆1248a随连杆196a与朝前惰轮1220a接触而退回。齿1602随环形槽1604的完全行程位于六点钟的位置，随着朝右的凸脊1610接近齿1602进行其逆时针旋转。在图51，51A中，一个发射冲程已发生，从而将一个远端连杆196b向上移动与向前的惰轮1220a接触。该齿1602已穿过固定凸轮1606的环形沟槽1604进行了三分之一圈的旋转。在图52，52A中，第二发射冲程已发生，从而使又一个连杆196c向上运动与朝前的惰轮1220a接触。该齿1602已穿过固定凸轮1606的环形沟槽1604进行了三分之二圈的旋转。在图53，53A中，第三发射冲程已经发生，将一远侧连杆196d向上运动与朝前的惰轮1220a接触。该齿1602已绕环形沟槽1604进行整圈的旋转成与挡块1608接触，从而激发了凸轮1606的逆时针旋转(当从右边看时)，使朝右的凸脊1608与防倒转解除杆1248a接触。在图54中，防倒转解除杆1248a对其作出响应而向远侧移动，从而将朝右的前销1298锁进远侧开放的阶梯结构1299中，并将防倒转机构1250解除。
虽然本发明已由对一些实施例的描述作出示例说明，并且虽然这些示例性实施例已经得到了相当详细的描述，但是申请人并不企图将后附的权利要求书限制或以任何方式限定到这此细节。其它的优点和修改对于本领域技术人员来说是显而易见的。
例如，在这里描述了虽然外科吻合和切割器械10，其有利地具有单独和不同的闭合和发射致动，提供了临床的弹性。然而，需要理解的是，与本发明相一致的应用可包括手柄，其将单个使用者致动转换为闭合及发射该器械的发射动作。
另外，虽然描述了手动致动手柄，但机动化的或其它动力手柄可得益于结合如这里描述的链接齿条，从而允许手柄尺寸的缩小或其它优点。例如，尽管部分地填充链接齿条到手枪式握把中是很方便的时候，应当理解的是，连杆之间的枢轴连接件允许填充平行于由手柄的轴和筒体定义的直线部的连杆。
作为另一实例，外科器械可包括直线齿条，其结合了与本发明的情况一致的特征，例如在击发行程结束时的自动退回和手动发射退回。

Claims (9)

1.一种外科器械，包括：
端部执行器，其响应纵向发射运动来进行外科手术操作；
与所述端部执行器连接的轴；
发射构件，其由所述轴滑动地接收，以在非发射位置和完全发射位置之间将发射运动传递给端部执行器；
固定在发射构件上的齿条；
发射机构，其在操作上被构造成在击发冲程中与齿条接合且使其向远侧运动，并在随后脱开接合；
与所述齿条啮合的齿轮机构；
包含齿条、发射机构和齿轮机构的手柄；以及
退回构件，其安装在手柄外部上以便进行旋转，且联接于齿轮机构上以便进行旋转，
其中，所述齿轮机构进一步包括棘轮，当齿条向远侧运动时，该棘轮沿第一方向旋转，且当齿条向近侧运动时，该棘轮沿第二方向旋转，并且所述退回构件包括齿轮退回杆及退回棘爪，该退回棘爪被定位成在致动齿轮退回杆时接合棘轮以沿第二方向转动棘轮，从而退回齿条和发射构件。
2.如权利要求1所述的外科器械，其特征为，所述齿轮机构进一步包括与所述齿条联接以与之成比例地转动的传动齿轮，所述退回构件包括一刻度盘，其包含把手构件，用于指示发射行程的量以及由使用者致动来反向驱动传动齿轮和齿条。
3.如权利要求2所述的外科器械，进一步包括：
发射触发器；
所述发射机构在操作上被进一步构造成通过在击发冲程之间脱开发射触发器而响应多个击发冲程来实现最大击发行程；
回位弹簧，其在近侧固定于齿条上，以维持其上的退回力；
防倒转机构，其被偏压以在击发冲程之间束缚发射构件；以及
防倒转解除机构，其在发射后脱开防倒转机构。
4.如权利要求1所述的外科器械，其特征为，所述齿轮机构进一步包括与齿条连接的惰轮，当齿条向远侧运动时，该惰轮沿第一方向旋转，当该齿条向近侧运动时，该惰轮沿第二方向旋转，该惰轮连接于单向离合器上，该单向离合器又与退回构件联接，该单向离合器在操作上被构造成当使退回构件沿第一方向相对于惰轮旋转时脱离接合。
5.如权利要求1所述的外科器械，进一步包括一回位弹簧，其在近侧固定在齿条上以促使其退回，该退回构件手动地辅助回位弹簧。
6.如权利要求5所述的外科器械，其特征为，所述发射机构在操作上被构造成响应多个击发冲程以使发射构件沿轴前进，该外科器械进一步包括：
可响应发射构件的近侧运动而接合发射构件的防倒转机构；以及
防倒转解除机构，其在操作上被构造成脱开与防倒转机构的接合；
其中，联接致动的齿轮退回杆以激活防倒转解除机构。
7.如权利要求6所述的外科器械，其特征为，所述防倒转机构包括：
锁定盘，其包括沿圆周包围发射构件的孔，该锁定盘在孔锁定地接合发射构件的锁定位置和孔滑动地接合发射构件的解锁位置之间枢转；
将锁定盘偏压至锁定位置的防倒转弹簧；以及
防倒转解除杆，其被定位成与防倒转弹簧的偏压力相对；
其中，所述齿轮退回杆包括一凸轮构件，其被定位成使防倒转解除杆向远侧运动。
8.如权利要求6所述的外科器械，其特征为，所述齿轮机构进一步包括：
与齿条啮合的惰轮，其大小被设定成响应齿条的最大发射行程转一圈；
凸轮，其响应惰轮以在最大发射行程的终点向远侧移动防倒转解除杆；以及
与惰轮啮合并包含棘轮的传动齿轮。
9.如权利要求6所述的外科器械，进一步包括一手柄，其包含齿条、发射机构以及齿轮机构，并进一步包括阻挡结构，其中，所述齿轮退回杆进一步包括一轮毂，其包含尺寸适于接收棘轮的凹槽，还包括被连接成在凹槽内枢转的棘爪以及阻挡机构，该机构被定位成在未致动齿轮退回杆时在棘轮上方保持棘爪。
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