CN101011277A - 用于吻合术的椭圆形腔内外科缝合器 - Google Patents
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Abstract
一种外科缝合器,包括储存有多个钉的头部。所述头部包括端面。所述缝合器还包括砧座,所述砧座具有形状和尺寸设置成当所述外科缝合器致动时形成钉的砧座表面,所述砧座包括与所述头部的端面相对的端面,用于与其匹配接合。所述头部的端面相对于该头部的纵向轴线倾斜定向,从而在该外科缝合器致动期间当所述头部与砧座接触时形成椭圆形钉线。
Description
技术领域
本发明涉及用于吻合术的外科缝合器。更具体地,本发明涉及在吻合过程中形成椭圆形轮廓的腔内外科缝合器。
背景技术
外科缝合器在外科领域作为连接或修复组织的快速有效的方法早就已知。钉缝合(stapling)已经变成线缝合(suturing)的可接受替代。在一些类型的外科手术中,外科手术钉的使用已经成为连接组织的优选方法,已经发展了特别构造的外科缝合器用于这些应用。
已经发展了腔内或者圆形缝合器在已知为吻合术的外科手术中使用。在美国专利US5,104,025中公开了在进行吻合术中使用的腔内外科缝合器的例子,该文献通过引用而包含在本申请中。
传统的腔内外科缝合器典型地包括细长轴,该细长轴具有近侧致动机构和安装在轴上的远侧缝合机构。远侧缝合机构典型地包括固定的缝合仓,在仓中容纳有构造为同心圆阵列形式的多个钉。圆形切割刀同心地安装在仓中并位于钉的内部。所述刀在操作期间沿轴向向远侧方向运动。从仓的中心沿轴向延伸的是套管针轴。套管针轴可相对于仓沿轴向运动。砧座构件安装在套管针轴上。砧座构件具有安装在其上的常规钉砧座表面,用于形成钉的末端。钉仓的远侧表面与钉砧座表面之间的距离可通过安装在套管针轴的近端上的调节机构来控制。当医生触发致动机构时,容纳在钉仓和钉砧座表面之间的组织可同时被缝合和切割。
如上简述,吻合术涉及其中在连接部分已经被切除之后部分肠被连接在一起的外科手术。手术要求将两个管状部分的末端连接在一起形成连续的管状通道。在引入腔内外科缝合器之前,该外科手术是费力耗时的手术。医生必须精确地切割并对准肠的末端,在使用大量的钉线连接管状部分的末端的同时还要保持这种对准。腔内外科缝合器的发展极大地简化了吻合手术,并且还缩短了进行吻合术所需的时间。
当使用腔内外科缝合器进行吻合术时,通常使用具有被定位在肠的目标部分的两侧上的双排钉的常规外科缝合器对肠进行缝合。在除去样本后,医生通常将腔内外科缝合器的砧座插入腔的近端,靠近钉线。这通过将砧座插入到由医生在近侧腔切割形成的进口来实现。偶尔,可经肛门设置砧座,也就是通过将砧座设置在缝合器的远端上并经过直肠插入器械。医生然后可使用缝合线或者其它常规结扎装置将肠的近端结扎在砧座轴上。之后医生切断结扎处附近的切除组织,并且将砧座连接到腔内外科缝合器的套管针轴。接着,医生闭合砧座和仓之间的缝隙,从而将肠的近端和远端接合在缝隙中。医生接着致动腔内外科缝合器,驱动几排钉穿过肠的两端,从而将末端连接在一起并形成管状通道。同时,当钉被驱动并形成时,同心圆形刀片被驱动穿过肠组织,切割靠近内排钉的末端。然后医生从肠中退出缝合器,吻合术完成。
通过沿着与腔的纵向轴线垂直的平面建立新形成的腔的钉线,在腔内产生巨大的应力。特别是,穿过腔的材料同时碰到钉线的所有边缘。这导致沿着钉线的较大应力。另外,钉线的强度受到钉线处腔的直径的限制以及周长的限制。
考虑到这一点,目前需要一种机构,优化由腔内外科缝合器形成的钉线的强度和功能性。本发明提供了这样一种器械。
发明内容
因此,本发明的一个目的在于提供一种椭圆形外科缝合器,其包括储存了多个钉的头部。该头部包括端面。外科缝合器还包括砧座,所述砧座具有形状和尺寸设置成当致动外科缝合器时用于形成钉的砧座表面,所述砧座包括与头部的端面相对的端面,用于与其匹配接合。头部的端面相对于头部的纵向轴线倾斜定向,在外科缝合器致动期间当头部与砧座接触时形成椭圆形钉线。
本发明的另一个目的在于提供一种包括储存有多个钉的头部的外科缝合器。所述头部包括端面。该外科缝合器还包括砧座,所述砧座具有形状和尺寸设置成当外科缝合器致动时用于形成钉的砧座表面,砧座包括与头部的端面相对的端面,用于与其匹配接合。砧座与头部的端面限定了倾斜配合的平面,由于砧座和头部的倾斜椭圆形轮廓,砧座和头部在所述平面上形成椭圆形钉线。
更具体地说,本发明涉及如下内容:
(1)一种椭圆形外科缝合器,包括:
头部,其中储存了多个钉,所述头部包括端面;
与头部连接的砧座,所述砧座包括形状和尺寸设置成当所述外科缝合器致动时形成钉的砧座表面,所述砧座包括与头部的端面相对的端面,用于与其匹配接合;
其中,所述头部的端面相对于该头部的纵向轴线倾斜定向,从而在该外科缝合器致动期间当头部与砧座接触时形成椭圆形钉线。
(2)如第(1)项所述的椭圆形外科缝合器,还包括保持在所述头部中的刀,用于切割保持在所述砧座和头部之间的组织。
(3)如第(1)项所述的椭圆形外科缝合器,其中,所述砧座的端面相对于该砧座的纵向轴线以倾斜角度定向。
(4)如第(1)项所述的椭圆形外科缝合器,其中,所述外科缝合器包括纵向轴线,所述头部的端面相对于该外科缝合器的所述纵向轴线以倾斜角度定向。
(5)如第(4)项所述的椭圆形外科缝合器,其中,所述砧座的端面相对于所述外科缝合器的纵向轴线以倾斜角度定向。
(6)如第(1)项所述的椭圆形外科缝合器,其中,所述砧座的端面包括阶梯状结构,并且所述头部的端面包括阶梯状结构。
(7)一种椭圆形外科缝合器,包括:
头部,其中储存有多个钉,所述头部包括端面;
与头部连接的砧座,包括形状和尺寸设置成当该外科缝合器致动时用于形成钉的砧座表面,所述砧座包括与所述头部的端面相对的端面,用于与其匹配接合;
其中,所述砧座与头部的端面限定倾斜配合的平面,由于所述砧座和头部的端面的倾斜椭圆形轮廓,所述砧座和头部在所述平面上形成椭圆形钉线。
(8)如第(7)项所述的椭圆形外科缝合器,还包括保持在所述头部中的刀,用于切割保持在所述砧座和头部之间的组织。
(9)如第(7)项所述的椭圆形外科缝合器,其中,所述头部的端面相对于所述头部的纵向轴线以倾斜角度定向。
(10)如第(7)项所述的椭圆形外科缝合器,其中,所述砧座的端面相对于所述砧座的纵向轴线以倾斜角度定向。
(11)如第(9)项所述的椭圆形外科缝合器,其中,所述砧座的端面相对于该砧座的纵向轴线以倾斜角度定向。
(12)如第(9)项所述的椭圆形外科缝合器,其中,所述外科缝合器包括纵向轴线,所述头部的端面相对于该外科缝合器的纵向轴线以倾斜角度定向。
(13)如第(12)项所述的椭圆形外科缝合器,其中,所述砧座的端面相对于所述外科缝合器的纵向轴线以倾斜角度定向。
(14)如第(7)项所述的椭圆形外科缝合器,其中,所述砧座的端面包括阶梯状结构,并且所述头部的端面包括阶梯状结构。
(15)一种腔内外科缝合器,包括:
头部,其中储存有多个钉,所述头部包括椭圆环形端面;
与所述头部连接的砧座,包括形状和尺寸设置成当所述外科缝合器致动时形成钉的砧座表面,所述砧座包括与所述头部的端面相对的椭圆环形端面,用于与其匹配接合;
其中,所述头部的端面相对于该头部的纵向轴线以倾斜角度定向。
(16)如第(15)项所述的椭圆形外科缝合器,还包括保持在所述头部中的刀,用于切割保持在所述砧座和头部之间的组织。
附图说明
通过下列详细描述并接合阐述本发明的一些实施方式的附图,本发明的其它目标和优点将是可以想见的。
图1是本发明的外科缝合器的透视图。
图2是本发明的外科缝合器的头部和砧座部分的透视图。
图3、4、5和6是本发明的关闭和缝合操作的侧视图。
图7是本发明的砧座、砧座轴和套管针的分解透视图。
图8是沿着图2的线8-8的砧座的局部剖视图。
图9是安放在如本发明所述的套管针尖端上的闭合的砧座轴的局部剖视图。
图10是沿着图9的线10-10截取的砧座轴的剖视俯视图。
图11是容纳在本发明的头部部分中的套管针护套机构的局部侧剖视图。
图12是根据本发明的替代实施方式的示意图。
图13和14是根据本发明的优选实施方式的头部和砧座的详示图。
具体实施方式
这里公开了本发明的具体实施方式。然而应当理解,所公开的实施方式仅仅作为以各种形式体现的本发明的示例。因此,这里公开的细节不解释为限制,而仅仅作为权利要求书的基础,以及作为教导本领域技术人员如何制作和/或使用本发明的基础。
参照各图,公开了根据本发明的腔内外科缝合器10。外科缝合器10在结构和操作上大体上类似于例如在下述文献中公开的那些腔内吻合外科缝合器,即,Main等人的共同拥有的题为“INTRALUMINAL ANASTOMOTIC SURGICAL STAPLER WITHDETACHED ANVIL”的美国专利US5,104,025和Welch的题为“CIRCULAR STAPLER TISSUE RETENTION SPRING METHOD”的美国专利US5,309,927,这两份文献的内容均通过引用而包含在本申请中。虽然根据本优选实施方式公开了优选缝合器设计,但是在不背离本发明的精神的条件下,本发明的构思可应用到各种缝合器设计。例如,可以想到,本发明可等同地被应用到采用可拆卸或者不可拆卸砧座的缝合器。本领域技术人员将会理解,术语腔内外科缝合器的意思是指设计为在吻合期间以环形围绕脉管或者器官的整个圆周应用钉的一类外科缝合器。
一般说来,外科缝合器10包括头部12、砧座14、调节螺帽16和触发器18。当保险被释放时触发器18动作以操作缝合器10。当触发器18被致动时,击发机构(未显示)在轴22中操作,使钉从头部12中被排出。这些钉围绕砧座表面24被压弯,所述砧座表面24围绕砧座主体26周向定位。同时,保持在头部12中的刀13(以虚线显示)动作以切割保持在砧座14和头部12之间、位于外科缝合器10的圆周内的组织。然后拉动缝合器10穿过组织,将缝合的组织留在其位置中。
从图1、2和7中所示那样公开了本发明的外科缝合器10。更具体地,从图1和2中可以看出,显示了含有套管针尖端30的套管针轴28。套管针轴28与头部1 2成一体并能够穿刺组织。套管针轴28由在头部12中往复进出的套管针套筒32环绕。套管针套筒32由形成其弹性并允许套管针套筒32围绕套管针轴28往复运动的弹簧34保持在头部12上。
从图3和11中可以看出,套管针轴28一般由套筒32覆盖,使荷包口式缝合的组织可被置于套管针套筒32之上。虽然如此,当施加压力时,套管针尖端30能够穿刺过组织。当连接荷包口式缝合的组织时这特别有用。这样,能够迫使暴露出套管针尖端30的套管针套筒32穿过荷包口式缝合组织,而荷包口缝合不被破坏。在迫使套管针套筒32穿过组织后,套管针套筒32围绕套管针尖端30,使得不发生进一步的伤害,但是腔被充分连接在套管针套筒32的上方。
砧座14与套管针轴28、套管针尖端30和套管针套筒32对应。如上所述,砧座14包括围绕砧座主体26周向定位的砧座表面24。砧座表面24与周向保持在头部12中的钉对应。从图3中可看到,砧座14还可设置在组织的腔中,然后围绕砧座轴36荷包口式缝合组织。砧座14中包含准直机构(见图8)。如图8所示,沿着砧座主体26形成锯齿38。这些锯齿38与套管针尖端30上包含的缺口或者凹槽52对应。当砧座14置于套管针轴28上方时,锯齿38找到对应的凹槽52,因而能够将砧座表面24与围绕头部12周向设置的钉对准。
根据本发明的第一和第二实施方式,头部12、12’和砧座14、14’的相应椭圆形、圆形端面40、40’、42、42’相对于它们穿过的腔的纵向轴线以倾斜角度定向。在外科缝合器带有具有纵向轴线的直支撑轴的情况下(见图1到11),头部12和砧座14的端面40、42相对于支撑套管针轴28的纵向轴线以倾斜角度定向。通过以这种方式定向头部12和砧座14的端面40、42,当垂直于切割平面观察时,由本发明的外科缝合器10作用在组织上产生的最终切割边缘实际上是椭圆形的。
由于相对于腔的纵向轴线倾斜的椭圆环切割可比垂直于相同腔的圆形切割具有更大的表面积,根据本发明形成的切割表面在相邻组织的缝合中提供了更大的表面积。这导致腔的相邻部分的更强力的接合以及当体液通过腔的切割表面时更小的干扰。
参照图1到11,并根据本发明的第一实施方式,头部12和砧座14的相应远端和近端形成有倾斜的端面40、42,它们限定了一个倾斜配合平面,砧座14和头部12在该平面上配合。通过以这种方式采用倾斜端面40、42,由于砧座14的近端和头部12的远端的倾斜椭圆形轮廓可形成椭圆形钉线。椭圆的弧形(arc)是倾斜角度的反余弦函数,本领域技术人员将会理解,通过简单改变头部12和砧座14的各个近侧和远侧端面40、42存在处的角度,可扩大和/或者缩小椭圆。换言之,倾斜越大,椭圆的面积越大,因而装置留下的腔的面积越大。
本领域技术人员当然可以理解,没有根据本发明公开的内容公开特定的钉。但是,应当理解,优选的是钉从头部的端面垂直离开头部,从而使它们以垂直于砧座端面的方式遇到砧座。这样在允许器械口的开口可变的同时仍可使钉保持对称结构,并且在被击发时钉仍然能与砧座相遇。这样的设计将需要套管针也从器械(钉从头部出射的地方)出射,并与倾斜切割表面垂直地和砧座相遇(形成砧座的凹处的地方)。
考虑到这一点,并根据参照图13和14公开的本发明的优选实施方式,砧座114和头部112的配合表面是阶梯状或者错位的,以形成根据本发明所需的椭圆形表面。更具体地,头部112和砧座114的各个远端和近端形成有倾斜端面140、142,它们限定倾斜配合平面,砧座114和头部112在该配合表面上相遇。倾斜端面140、142分别包括由一系列小平面(land)143和竖面145构成的阶梯状结构。小平面143和竖面145以形成端面的方式围绕各自的倾斜端面140、142延伸,所述端面存在于相对于外科缝合器110的纵向轴线倾斜定向的平面中。
根据该实施方式使用的钉沿着垂直于小平面143的方向从头部112出射,钉与所述小平面143相关联并抵靠与其对准的砧座114的小平面143而形成。结果,通过提供与砧座114的接触表面和头部112的出射表面垂直定向的钉致动,阶梯状结构的使用解决了上面提到的钉形成问题。
如上所述,在该方式中通过采用倾斜端面140、142,形成椭圆形钉线,其中椭圆的弧形是倾斜角的反余弦。基于组成倾斜端面140、142的小平面143和竖面145的正确对准,阶梯状结构的使用还增强了头部112和砧座114可靠一致地闭合能力。
尽管上面根据本发明的优选实施方式公开了阶梯状表面,本领域技术人员将会理解,在不背离本发明的精神的条件下也可采用实现椭圆形构造的其它错位构造。
参见图12,根据本发明提供的椭圆形也可通过下述方式来形成,即,将缝合器的整个远端倾斜,从而使头部112’和砧座114’在相对于缝合器10’的轴的纵向轴线倾斜定向的平面中相遇。更具体地,头部12’的远端处的椭圆环形端面40’与其穿过的腔的纵向轴线以及头部12’的纵向轴线作为一个整体倾斜定向。砧座14’的近端处的椭圆环形端面42’与其穿过的腔的纵向轴线倾斜但垂直于其本身的砧座14’的纵向轴线定向。这样,砧座14’沿着基本与沿着头部12’的远端的端面42’所位于的平面垂直的线运动成与头部12’接触。
在如图3、4、5和6所示的操作中,具有分别与套管轴28及管形砧座延伸部分36都连接的两个腔的砧座14准备用于外科手术。如图4所示,砧座14置于套管针轴28上,使套管针尖端30暴露并配合在砧座轴36中。套管针套筒32被推到暴露位置,使其在头部12中伸缩。当套管针充分定位在砧座头部26中时,导致含有楔形弹簧的锁定夹46打开,然后围绕切口50夹持。由于凹槽52本身与套管针轴28中的锯齿38对准,它确保砧座表面24与容纳在头部12中的钉对准。如图7最清楚所示的,在制造过程中当将砧座头部26与管形砧座延伸部分36连接时通过将凸起52精确设置在孔54中,锯齿38已经与砧座表面24对准。然后调节螺帽16将组织彼此拉近。
如图6所示,钉已经被击发到砧座表面24中穿过组织。一旦钉打弯,刀13切割保持在钉周围的组织。一旦这种切割发生,就沿着头部12的方向拉动缝合器10并穿过腔,从而形成具有内部管状开口的周向封闭的腔。
在移除缝合器10后,保持在缝合器10中的过量的腔被处理。按压砧座14上的脱扣44,如图2及10所示。这引起如图9中所示的锁定机构打开,如图7中所示。锁定夹46现在打开,允许用户从缝合器头部12滑动砧座轴36。组织被保持在砧座14中,然后除去头部12。
这样,已经通过在凹槽52和锯齿38之间对准的套管针轴28正确形成荷包口式缝合并穿刺,经过砧座主体26拉动围绕切口的锁闭夹46,正确地缝合并切割组织。
虽然已经现实并描述了本发明的优选实施方式,应当理解,并不是想通过所述公开限制本发明,而是试图覆盖所有修改,所有替代构造均落入本发明的精神和范围内。
Claims (6)
1、一种椭圆形外科缝合器,包括:
头部,其中储存了多个钉,所述头部包括端面;
与头部连接的砧座,所述砧座包括形状和尺寸设置成当所述外科缝合器致动时形成钉的砧座表面,所述砧座包括与头部的端面相对的端面,用于与其匹配接合;
其中,所述头部的端面相对于该头部的纵向轴线倾斜定向,从而在该外科缝合器致动期间当头部与砧座接触时形成椭圆形钉线。
2、根据权利要求1所述的椭圆形外科缝合器,还包括保持在所述头部中的刀,用于切割保持在所述砧座和头部之间的组织。
3、根据权利要求1所述的椭圆形外科缝合器,其中,所述砧座的端面相对于该砧座的纵向轴线以倾斜角度定向。
4、根据权利要求1所述的椭圆形外科缝合器,其中,所述外科缝合器包括纵向轴线,所述头部的端面相对于该外科缝合器的所述纵向轴线以倾斜角度定向。
5、根据权利要求4所述的椭圆形外科缝合器,其中,所述砧座的端面相对于所述外科缝合器的纵向轴线以倾斜角度定向。
6、根据权利要求1所述的椭圆形外科缝合器,其中,所述砧座的端面包括阶梯状结构,并且所述头部的端面包括阶梯状结构。
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- 2007-01-31 CN CN2007100069435A patent/CN101011277B/zh not_active Expired - Fee Related
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- 2007-01-31 SG SG200700734-7A patent/SG134309A1/en unknown
- 2007-01-31 BR BRPI0700215-7A patent/BRPI0700215A/pt not_active Application Discontinuation
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JP5111877B2 (ja) | 2013-01-09 |
TW200740405A (en) | 2007-11-01 |
RU2007103787A (ru) | 2008-08-10 |
JP2007209751A (ja) | 2007-08-23 |
CA2575657A1 (en) | 2007-08-01 |
AU2007200143A1 (en) | 2007-08-16 |
TWI414266B (zh) | 2013-11-11 |
MX2007001301A (es) | 2009-02-12 |
KR101350203B1 (ko) | 2014-01-13 |
KR20070079321A (ko) | 2007-08-06 |
IL180754A0 (en) | 2007-06-03 |
SG134309A1 (en) | 2007-08-29 |
DE602007000923D1 (de) | 2009-06-04 |
CN101011277B (zh) | 2011-06-29 |
CA2575657C (en) | 2015-01-20 |
BRPI0700215A (pt) | 2007-11-06 |
RU2447851C2 (ru) | 2012-04-20 |
AU2007200143B2 (en) | 2012-04-19 |
EP1815805B1 (en) | 2009-04-22 |
US7422138B2 (en) | 2008-09-09 |
US20070175963A1 (en) | 2007-08-02 |
ATE429176T1 (de) | 2009-05-15 |
EP1815805A1 (en) | 2007-08-08 |
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