CN101500497B - 外科缝合器械以及用于这样的器械的钉仓和缝钉 - Google Patents
外科缝合器械以及用于这样的器械的钉仓和缝钉 Download PDFInfo
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Abstract
一种外科缝合器械，包括：包括钉仓装置(5；30)和钉砧(1；32)的缝钉固定组件(1，5；24)，所述钉仓装置包括至少一排缝钉(72，77)和大体波浪形的第一组织界面(34)，所述钉砧相对于所述钉仓装置(5；30)可活动并且具有大体波浪形的第二组织界面(36)，所述第二组织界面适于与所述钉仓装置(5；30)的第一组织界面(34)配合以用于夹紧在它们之间的组织并使从所述钉仓装置(5；30)离开的缝钉(72，77)的末端(74)成形；缝钉驱动装置(60；90)，其适于朝着所述钉砧(1；32)将缝钉(72，77)驱动到所述钉仓装置(5；30)之外，其中所述缝钉包括一个或多个U形的不对称缝钉(77)，所述缝钉具有两个支脚(78)和连接所述支脚(78)的横向基部(79)，所述支脚带有面朝着所述钉砧(1；32)的自由尖端(74)，其中所述基部(79)相对于所述支脚(78)的纵向(81)倾斜，使得所述基部(79)的长度大于它在垂直于所述支脚(78)的纵向(81)的平面(80)上的投影。
Description
技术领域
本发明涉及一种外科缝合器械，其能够用于将外科缝钉应用到组织，尤其用于执行吻合术。本发明还涉及一种用于这样的外科缝合器械的钉仓装置和一种外科缝钉。
背景技术
通常，在外科吻合缝合操作的执行中，两段内腔或管状组织例如肠组织通过闭合的缝钉排连接在一起。在用外科缝合器械执行吻合术的过程中，两段管状组织一起被夹在钉砧和缝钉保持器或钉仓装置之间，所述钉砧设有缝钉成形凹槽阵列，所述缝钉保持器或钉仓装置设有布置成闭合排或阵列的多个缝钉接收槽，缝钉被接收在所述缝钉接收槽中。缝钉推动器被推进以将缝钉驱入组织中并且抵靠钉砧成形缝钉。而且，环形刀具或切割刃被推进以切割夹在钉砧和缝钉保持器之间的多余组织。
结果，组织的环形部分从每个内腔被切断并且保留在钉砧轴上。通过相对于缝钉保持器移动钉砧，通常通过朝远侧推进钉砧轴以远离缝钉保持器移动钉砧，使通过闭合的缝钉排连接的管状组织松开。通过牵引钉砧通过由缝钉阵列连接的管状组织段所限定的吻合孔口，缝合器械被取出。
就缝钉排而言，它通常包括重叠或非重叠布置的一组单金属或合成的缝钉，并且每个缝钉具有基本对称的形状，两个纵向支脚由垂直于所述支脚的纵向的横向冠部或基部连接。传统上，钉砧与缝钉保持器或钉仓装置的相对组织界面(即，直接接触和夹紧它们之间的组织的表面)具有垂直于钉砧和钉仓装置之间的相对运动的方向的平面形状。该结构导致缝合的接缝，因此导致吻合内腔的圆周比圆形缝合器的外圆周更短。结果，常常难以从手术部位缩回器械，原因是难以移动钉砧通过由闭合的缝钉排约束的稍硬的开口。而且，在手术之后，在吻合部位的临床狭窄的发生率并不鲜见。
为了克服该问题，提出了缝合器的组织界面的大致波浪形结构。由于该波浪形状和产生的组织界面相对于缝合器的夹紧方向的倾斜，组织界面和产生的缝合接缝的总长度大于它们的线性延伸尺寸。换句话说，组织界面的总长度大于它们在垂直于缝合方向的平面上的投影。这样，对于给定的缝合器尺寸，缝合接缝的长度和因此产生的吻合孔口的圆周和直径可以增大。这些已知的外科缝合器械的例子在WO 01/54594(圆形缝合器)和EP 1254636A2(线性缝合器)中被公开。
尽管已知的外科缝合器械非常有益并且大大促进了吻合术或其它类型的外科缝合和切除的执行，它们仍然存在一些问题。缝合接缝相对较硬并且倾向于保持它的波浪形并且有时呈皱缩形状，使得缝合部位的展平和加宽导致不希望的组织张紧。该组织张紧会导致术后束紧和狭窄。这些并发症的发生率的减小是人们希望的。
而且，由于组织界面的波浪形状和限定缝钉排的线的波浪形状，通常缝钉必然以与垂直于缝合方向的平面成变化角被驱动和成形。这增加了缝钉驱动装置的复杂性，并且诸如在常规缝合器械中的简单轴向驱动机构通常是不够的。
发明内容
鉴于现有技术的上述缺陷，本发明的目的是提供一种例如用于执行吻合术的外科缝合器械，其中所述器械能够产生比现有技术可获得的那些器械更软且通常更长的缝合接缝，以便消除不希望的组织张力并减小愈合过程期间有害的临床并发症的风险。
在基本目的的总体范围内，本发明的另一目的是提供一种外科缝合器械，其具有大致波浪形组织界面，但是具有比现有技术中已知的那些器械更简单的缝钉驱动机构。
本发明的又一目的是提供一种用于该外科缝合器械中的钉仓装置和外科缝钉。
这些和其它目的通过一种外科缝合器械实现，所述外科缝合器械包括：框架，其具有主体部分和手柄；在所述器械的远侧区域中的缝钉固定组件，所述缝钉固定组件包括钉仓装置和钉砧，所述钉仓装置包括至少一个缝钉排和大致波浪形的第一组织界面，所述钉砧相对于所述钉仓装置可活动并且具有大致波浪形的第二组织界面，所述第二组织界面适于与所述钉仓装置的第一组织界面配合以用于夹紧在它们之间的组织并使从所述钉仓装置离开的缝钉的末端成形；移动装置，其适于相对于所述钉仓装置移动所述钉砧；缝钉驱动装置，其适于朝着所述钉砧将缝钉驱动到所述钉仓装置之外，
其中所述缝钉包括一个或多个基本呈U形的缝钉，所述U形缝钉具有两个支脚和连接所述支脚的横向基部(所谓的“冠部”)，所述支脚带有面向所述钉砧的自由尖端，其中所述基部相对于所述支脚的纵向倾斜，使得所述基部具有的长度大于它在垂直于所述支脚的纵向的平面上的投影。这允许使可以被看作一连串重叠缝钉“冠部”的缝合接缝的局部取向适合于被夹紧组织的波浪形取向，并且同时，沿着缝合器械的相同“击发”方向驱动所有缝钉，所述“击发”方向相对于被夹紧组织的取向倾斜。结果，有可能借助于简化的缝钉驱动机构获得更长并且更软的缝合接缝。有利地，每个缝钉被布置在钉仓装置中，使得它的基部基本沿着与第一组织界面的相应部分的方向平行的方向延伸，缝钉可由缝钉驱动装置通过所述相应部分排出，并且所有缝钉的支脚沿着基本相同的缝钉驱动方向，即缝合器的“击发”方向延伸。
根据本发明的一种实施方式，所述缝钉驱动装置包括推动器，所述推动器具有直接接触缝钉的倾斜基部的倾斜推动表面，其中所述推动表面相对于垂直于所述缝钉驱动方向的平面倾斜，并且沿着与第一组织界面的相应部分的方向平行的方向延伸。这允许提供带有多个一体化连接的推动器的非常简单的缝钉驱动机构，所述推动器可以沿着相同的方向被一起推进和缩回。
根据一种优选实施方式，缝钉的倾斜基部是基本直的并且与垂直于缝钉支脚的纵向的平面限定在5°至85°之间、优选在20°至70°之间、更优选在30°至60°之间的角度。具有不同缝钉基部倾角的各种缝钉可以被提供，以便使由布置在钉仓中的缝钉的冠部限定的曲线适合于由所述缝合器械的波浪形组织界面限定的曲线。
优选地，所述缝钉具有一种形状使得完全在单一平面内延伸。
根据本发明的一个重要方面，所述钉仓装置限定多个导槽，所述导槽适于可滑动地容纳所述缝钉并且在第一组织界面中展开，其中所有导槽彼此平行并且沿着对应于所述缝合器械的“击发”方向的相同轴向缝钉驱动方向延伸，导致缝钉驱动机构的明显简化。
附图说明
通过附图及对其所作的描述可以明显得到本发明的这些和其它特征和优点，附图及对其所作的描述示出了本发明的实施方式，并且与上面给出的本发明的总体描述和下面给出的对实施方式的详细描述一起用于解释本发明的原理。
图1是根据本发明的外科缝合器械的第一实施方式的缝钉固定组件的示意性等轴测图，其中，钉砧被从钉仓装置移除(打开位置)；
图2是由具有波浪形缝钉线的外科缝合器械形成的环形肠接缝的几何形状的等轴测图；
图3是当图1的器械被插入到肠(直肠)中并且钉砧被闭合时该器械的示意图，其中波浪形肠接缝被显示；
图4是类似于图3的视图，当肠接缝具有功能上更长的周长时它在平面状态下被显示，并且钉砧被显示为在打开位置；
图5是根据本发明的外科缝合器械的第二实施方式的侧视图；
图6是图5的缝合器械的远端部分的放大视图；
图7是图5的缝合器械的钉砧的缝钉成形面的等轴测图；
图8是图5的缝合器械的圆形刀具及其配对物的等轴测图；
图9是图8中所示的配对物的局部剖视图；
图10是图5的缝合器械的缝钉驱动装置的远侧部分的侧视图；
图11是图10的缝钉驱动装置的俯视图；
图10A和11A分别是根据本发明的另一实施方式的缝钉驱动装置的远侧部分的侧视图和俯视图；
图12和图13是图5的缝合器械的缝钉驱动机构的细部放大图；
图14是根据本发明的外科缝合器械的另一种实施方式的缝钉驱动装置的末端部分的等轴测图；
图15是图14的缝钉驱动装置的末端部分的侧视图；
图16是用于根据本发明的外科缝合器械中的根据本发明的缝钉的侧视图；
图17是装载图16中所示的缝钉的缝钉驱动机构的细节的侧视图；
图18是用于根据本发明的外科缝合装置中的根据本发明的一种实施方式的钉仓装置的细节的等轴测透视图；
图19是现有技术中已知的对称缝钉和根据本发明的非对称缝钉的侧视图；
图20至22分别是带有适用于根据本发明的缝钉和钉仓装置的线性缝合部件的更多外科缝合器械的示意性侧视图；
图23是根据本发明的外科缝合器械的另一种应用的示意图。
具体实施方式
参见附图，图1至4借助于一种实施方式示出了根据本发明的外科缝合器械的基本概念和功能。
在图1中可以看到，钉砧1的波浪形缝钉成形面2(具有环形或圆形横截面)和钉仓装置5的波浪形端面6(也具有环形或圆形横截面)可以彼此适配。钉砧1和钉仓装置5的连接由刚性固定到钉砧1的轴3和容纳在钉仓装置5的中央中的可升降套管针4(其包括套管针轴)保证。具有波浪形切割刃的刀具7被定位在钉仓装置5内。而且，沿着钉仓装置5的波浪形端面6的闭合的两个缝钉排由短虚线示出。
图1的缝合器械按以下方式操作：以通常的方式，将钉砧1插入患者的肠(直肠)的口端11中，并且将钉仓装置5插入肠(直肠)的对口端12中(图3)。在吻合术中指定待连接的内腔或组织部分可以使用缝线或其它常规系着技术系着到钉砧轴和/或套管针轴上。在这之后，将套管针4连接到轴3上，然后通过降低套管针4，使钉砧1的波浪形缝钉成形面2和钉仓装置5的波浪形端面6朝着彼此移动。在这之后，使用位于钉仓装置5中的缝钉，通过“击发”器械完成波浪形肠接缝。
同时，具有圆形横截面的波浪形刀具7切掉不必要的肠部分。通过升高套管针4，器械被打开并且钉砧可以被方便地牵引通过肠接缝10，该肠接缝能够在功能上伸展到更长的周长(图4)。
图2示意性地示出了由图1的缝合器械形成的波浪形肠接缝9。由于下面将详细描述的缝钉的具体形状和缝钉驱动机构的配置，肠接缝9比现有技术的器械可获得的缝合接缝更软，由此允许直径更大的通道，如图4中所示。
这方便了器械的取出并且减小了产成缝合不全和肠接缝束紧的风险。
借助于图5至13解释根据本发明的外科缝合器械的另一种实施方式。
图5是完整的外科缝合器械20的侧视图。缝合器械20包括具有主体部分的框架，所述主体部分包括轴22和手柄26。缝钉固定组件24安装在轴22的远端。在该实施方式中，如果需要的话，缝钉固定组件24可以从轴22移除并且由另一个替换。
致动器把手28位于缝合器械20的近侧区域中。它可以朝着手柄26旋转，以便“击发”缝合器械20，即，用于操作缝合器械的内部机构的缝钉驱动装置和刀具致动装置。旋钮29可以旋转，以便使相当于图1的套管针4的套管针轴轴向地移位，从而打开或闭合缝钉固定组件24，即，移动缝合器械20的钉砧。
通常，缝合器械20的总体设计以及机械部件和驱动机构与已知的缝合器械(例如WO 01/54594)相同；然而，形成缝钉线的缝钉的三维布置和形状以及缝钉驱动装置的一些细节是不同的，这在下面进行解释。
图6是连接到轴22上的缝钉固定组件24的放大图。缝钉固定组件24包括钉仓装置30和钉砧32。钉仓装置30包括含有闭合的两个缝钉排的固定地形成一体的钉仓或可拆卸的一次性钉仓。钉仓装置的端面34具有波浪形状，如图6中所示。因此，限定基本沿着端面34的闭合的缝钉排的线也具有波浪形状并且未被限制于与缝钉固定组件24的纵向轴线垂直的平面，钉砧32具有缝钉成形面36，该缝钉成形面也是波浪形的，并且匹配钉仓装置30的端面34的波浪形状，参见图6。
图7是钉砧32的缝钉成形面36的等轴测图。缝钉成形面36包括多个缝钉成形凹槽38，所述凹槽在内侧被布置成闭合的第一排40并且在外侧被布置成闭合的第二排42。缝钉成形凹槽38沿着波浪形状被布置，但是仍然相对于缝钉驱动方向垂直。它们也指示钉仓装置30中的被布置在内侧闭合的第一排和外侧闭合的第二排中的相应缝钉的位置，所述排的单个缝钉彼此交错。在该实施方式中，波浪形状包括带有波峰44和波谷46的六个完整的波长，参见图7。在这里，名称“波峰”和“波谷”与限定闭合的缝钉排的线的波浪形状有关。
类似于图1中所示的第一实施方式，钉砧32包括中空轴48，该中空轴可以连接到沿着钉仓装置30的纵向轴线延伸的套管针轴。夹子机构49用于将钉砧轴48锁定到套管针轴。
图8示出了具有闭合的和波浪形的切割刃52的刀具50。借助于安装法兰54，刀具50连接到刀具致动装置，使得刀具50在内侧闭合的缝钉排的内侧被包含在钉仓装置30内。切割刃52的波浪形状的波峰和波谷与钉仓装置30的端面34的波峰和波谷对准。通过刀具致动装置，当致动器把手28被类似于常规缝合器械操作时，刀具50可以朝着钉砧32移动。
钉砧32包括配对物56，当钉砧32连接到钉仓装置30时，所述配对物与刀具50对准，参见图7和8。配对物56优选地由塑性材料制造并且包括两个侧壁57，和在波浪形端面58处的薄壁59，参见图9。在切割动作的初始阶段期间，壁59支撑将由刀具50切割的组织，并且之后切割刃52穿透在功能上类似于已知的切割垫圈的壁59。
图10是缝合器械20的缝钉驱动装置60的远侧部分的侧视图。当致动器把手28被操作时，缝钉驱动装置60沿着图10中所示的箭头的方向移动，导致缝钉穿透夹在钉仓装置30和钉砧32之间的组织。与现有技术的较为复杂的缝钉驱动装置(例如WO 01/54594)相比，所有缝钉沿着相同的轴向方向，例如沿着图10中的箭头的方向被驱动。由于下面所述的缝钉的形状和缝钉推动器的配置，本发明避免了必须沿着基本垂直于钉仓装置30的端面34的局部表面的方向移动单个缝钉，由此允许简化缝钉驱动装置60。
在缝钉驱动装置60中，在轴22内部被引导的致动器轴62支撑由肋65加强的基板64。如图10和11中所示，两排推动器从基板64凸出，即，在内侧的总共十二个第一推动器66、67的圆形排和在外侧的总共十二个第二推动器68的圆形排。第一推动器包括位于限定闭合的第一缝钉排的线的波峰的位置的长推动器66和位于该线的波谷的位置的短推动器67，其中每个第一推动器具有垂直于轴向缝钉驱动方向的基本直的推动表面。第二推动器68包括倾斜推动表面70，该表面相对于垂直于轴向缝钉驱动方向的平面倾斜或成一定角度，参见图10。每个第二推动器68被布置成交错并且分别与两个相邻的第一推动器66，67在圆周上重叠，参见图11。而且第二推动器68的倾斜推动表面70是基本直的，并且沿着平行于钉仓装置的端面58、34的相应部分的方向延伸，缝钉可由缝钉驱动装置通过所述相应部分排出。
图12是示出第一推动器中的一个的操作的放大纵向截面，在该情况下所述推动器中的一个是用于驱动位于限定闭合的第一缝钉排的线的波谷的缝钉72的第一推动器67。
缝钉72具有大体U形的对称形状，带有终止于两个自由尖端74的两个纵向支脚73和在与自由尖端74相对的一侧连接支脚73的横向基部75(所谓的“冠部”)。两个支脚73近似地是直的，并且基本沿着对应于轴向缝钉驱动方向的相同纵向延伸，基部75是基本直的，并且垂直于支脚73的纵向。缝钉72可滑动地容纳于在钉仓装置30中限定的导槽76内部。缝钉72的尖端74指向在钉砧32的缝钉成形面36处的相应缝钉成形凹槽38。当缝钉驱动装置60沿着远侧方向，即朝着钉砧被推进时，第一推动器67沿着轴向缝钉驱动方向移动并且在导槽76的引导下驱动缝钉72通过夹在钉仓装置30的端面34和钉砧32之间的组织，直到缝钉72的自由端74借助于缝钉成形凹槽38被成形。
位于缝钉线的波峰的第一推动器66以相同的常规方式工作。由于闭合的第一缝钉排的缝钉72位于缝钉线的波峰和波谷，包括第一推动器66、67和常规形状的外科缝钉72的轴向运动的常规驱动机构获得以垂直方式局部穿透组织并且固定缝钉的预期效果，所述缝钉具有基本等于相应的局部组织长度的局部“冠部”长度。
图13示出了第二推动器68的操作，所述第二推动器被配置成借助于它的倾斜推动表面70施加闭合的第二缝钉排的缝钉77。
缝钉77位于波浪形缝钉线的波峰和波谷之间并且将通过与缝合器械的“击发”方向，即与它的轴向缝钉驱动方向非正交的端面34、58的一部分被排出。所以，根据本发明，与本领域中已知的缝钉相比，缝钉77被给予显著不同的形状。特别地，缝钉77具有大体U形的不对称形状，带有终止于两个自由尖端74的两个纵向支脚78和在与自由尖端74相对的一侧连接支脚78的横向基部79(所谓的“冠部”)。两个支脚78优选为近似地是直的，并且基本沿着对应于轴向缝钉驱动方向的相同纵向延伸，基部79优选是直的，并且相对于垂直于支脚78的纵向81的平面80倾斜(即，偏斜或成一定角度)。在基部79和平面80之间限定的倾角α有利地在5°至85°之间、优选在20°至70°之间、更优选在30°至60°之间，并且被选择成使得至少获得缝钉基部79和钉仓30的相应端面34，58的近似平行取向。
优选地，缝钉77完全在单一平面内延伸。
根据一种实施方式，缝钉77的支脚78包括细长的基本部分82和细长的末梢部分83。基本部分82稍稍彼此偏离，同时从基部79朝着末梢部分83延伸，使得与基部79一起限定不规则梯形，该梯形具有由基部79限定的它的短底边和由基本部分82限定的它的两个斜边。末梢部分83优选地基本彼此平行，或者替代地，它们稍稍从基本部分82朝着它们的尖端74会聚。通常，两个缝钉支脚78的末梢部分83的平均或中间方向(average or mean direction)将限定缝钉77的纵向81。
根据本发明的缝钉77优选地由金属材料制造并且通过从环形金属丝切割一定长度并且在单一平面中将它们弯曲成上述不对称形状而制成。
缝钉77可滑动地容纳于在钉仓装置30中限定的导槽84内部。导槽84沿着与上述导槽76非常相同的轴向缝钉驱动方向延伸。有利地，所有导槽76、84沿着相同的方向延伸。缝钉77的尖端74指向在钉砧32的缝钉成形面36处的相应缝钉成形凹槽38。
当缝钉驱动装置60沿着远侧方向，即朝着钉砧被推进时，第二推动器67沿着轴向缝钉驱动方向移动并且在导槽84的引导下，具有与倾斜缝钉基部79基本相同的取向并且与所述缝钉基部79直接接触的它的倾斜推动表面70驱动缝钉77通过夹在钉仓装置30的端面34和钉砧32之间的组织，直到缝钉77的自由端74借助于缝钉成形凹槽38被成形。
图10A和11A示出了带有两排推动器68′、68″的缝钉驱动装置的一种替代实施方式，所述推动器包括相对于垂直于轴向缝钉驱动方向的平面倾斜或成一定角度的倾斜推动表面70′、70″，参见图10A。内排的每个推动器68′被布置成交错并且分别与外排的两个相邻的推动器68″在圆周上重叠，参见图11A。推动器68′、68″的倾斜推动表面70′、70″是基本直的，并且沿着平行于钉仓装置的端面58、34的相应部分的方向延伸，缝钉可由缝钉驱动装置通过所述相应部分排出。在该配置中几乎所有缝钉(限定波浪的波峰和波谷的缝钉除外)可以具有倾斜基部，由此简化了缝钉装载到钉仓中。波浪形状的顶点可以由传统缝钉或由在顶点的区域中稍稍重叠的带有反向倾斜基部的两个缝钉覆盖。
由于与钉仓装置的端面34、58倾斜的轴向驱动方向和与倾斜缝钉基部79和与端面34、58的相应(倾斜)部分平行的倾斜推动表面70的组合，包括第一推动器66、67和第二推动器68的轴向运动的常规驱动机构获得局部穿透组织并且固定缝钉的预期效果，所述缝钉具有基本等于相应的(倾斜)局部组织长度的(倾斜)局部“冠部”长度。在该情况下，穿透方向不再垂直于而是稍稍倾斜于组织平面，从而允许产生的波浪形缝合接缝的倾斜部分的更好展平而基本不张紧组织。
图16、17、18和19更详细地显示了根据本发明的缝钉形状、缝钉相对于缝钉固定装置的波浪形端面的取向、推动器的倾斜推动表面的取向和缝钉驱动方向之间的基本关系。
图14和15显示了缝钉驱动装置的远侧部分90的另一种实施方式。在该情况下，致动器轴92支撑套管结构94，所述套管结构具有带波峰96和波谷97的波浪形末端。波峰96和波谷97之间的倾斜区域起到与图10和11的实施方式的倾斜推动表面70类似的作用并且适于直接接触和接合缝钉77的倾斜缝钉基部79，而不用如现有技术的装置中发生的那样插入任何中间部件。
图23显示了使用根据本发明的外科缝合器械的不同方式，其中外科器械与传统缝钉，即与具有基本垂直于支脚的基部的缝钉结合使用。由于推动器的倾斜推动表面70和在钉砧缝钉成形表面处的缝钉成形凹槽的轴向偏移布置，在缝合器的操作期间，传统缝钉将首先变形为一种形状，其中基部相对于支脚(虚线)倾斜，并且之后自由尖端将向内钳紧(点划线)，由此将缝钉固定到组织。
当使用外科缝合器械20时，它的轴22和缝钉固定组件24被引入待执行吻合术的中空器官中。通常，该器官的一个部分的末端区域被放置在钉仓装置30的端面34上，而另一部分的末端区域被放置在钉砧32上，使得钉砧轴48伸出和将钉砧32连接或者可以用于连接到钉仓装置30。借助于通过旋钮29操作的上述移动装置，钉砧32相对于钉仓装置30移动，直到钉砧32与钉仓装置30之间的剩余间隙基本由中空器官的两个部分的组织填满。在该外科缝合器械的一种优选实施方式中，有可能以明确限定的方式调节该间隙的大小。其后，缝钉驱动装置60借助于致动器把手28被致动，以便朝着钉砧32将缝钉驱动到钉仓装置30之外。缝钉的尖端穿透其间的组织并且由钉砧32弯曲使得缝钉被闭合。之后，刀具致动装置朝着钉砧32移动刀具50，使得刀具50的切割刃52穿透组织。刀具致动装置优选地联接到缝钉驱动装置，使得只有必须操作致动器把手28才能执行几乎同时缝合和切割组织的功能。相对于彼此交错的闭合的两个缝钉排的存在保证了中空器官的两个部分的可靠连接。
在该程序结束时，在钉仓装置30和钉砧32之间的间隙增加之后，外科缝合器械20可以缩回，以便释放夹紧的和缝合的组织边缘。闭合的缝钉排的形状提供了缝钉线的相对大的总长度，使得在吻合部位的组织可以屈服并且钉砧32可以容易地移动通过由刀具50的切割刃52形成的开口。被切除的组织部分保留在外科缝合器械20中。
尽管详细描述了圆形外科缝合器械的一种实施方式，申请人的目的并非是将权利要求的范围限制为这样的特定缝合器械。根据本发明的缝钉77可以有利地用于具有这样的组织界面的不同钉仓装置和不同外科缝合器，所述组织界面相对于缝钉驱动方向至少部分地倾斜。
图20至22显示了具有基本线性的打开缝合钳口的外科缝合器械的例子，所述钳口带有波浪形组织界面和缝钉驱动装置和缝钉，所述缝钉以与关于图12、13、16、17、18和19的实施方式所述的相同方式被成形、布置和相对于波浪形组织界面可活动。
图20中所示的器械100包括带有一体化手柄和钳口组件(即，缝钉固定组件)102的主体部分101。钳口组件102包括钉仓装置103和钉砧105，所述钉仓装置包括波浪形的第一组织界面104，所述钉砧包括波浪形的第二组织界面106。在该实施方式中，钉仓装置103包含例如上述类型的缝钉的四个平行直排(在图中示意性地指示了几个缝钉77)和沿着缝钉布置的中心线延伸的刀具，所述刀具用于顺序地切割夹在钉仓装置103和钉砧105之间的组织。
为了操作器械100，钉砧105借助于杆107以平行关系朝着钉仓装置103移动，以便抓紧或夹紧在钉仓装置103和钉砧105之间的组织。在图3所示的状态下，杆107在平行于主体部分101的位置旋转。然后致动器108沿着主体部分101朝远侧方向被推动，导致缝钉从钉仓装置103排出以用于穿透组织，缝钉的尖端由钉砧105弯曲，并且使刀具从钉仓装置103的近端区域109移动到远端区域110以用于顺序地切割组织。
图21显示了由附图标记200表示的又一外科器械，该外科器械适合使用根据本发明的缝钉和钉仓装置。器械200包括手柄部分201、轴202和在轴202的远端处的钳口组件(即，缝钉固定组件)203。图22显示了带有钉仓装置204和钉砧205的钳口组件203。鉴于在器械100中各自的钉仓装置和钉砧平行于器械的纵向轴线对准，钉砧205和钉仓装置204相对于轴202横向延伸，与吻合缝合器械的第一实施方式相同。器械200被设计成用于开放式手术。钉砧205刚性地连接到轴202的延伸部，并且钉仓装置204可以朝着和远离钉砧205移动，同时保持设在钉仓装置204处的波浪形第一组织界面206和设在钉砧205处的波浪形第二组织界面207之间的平行关系。缝钉形状和布置以及缝钉驱动装置与关于其他实施方式描述的那些类似。在图22中示意性地指示了几个缝钉77和它们在钉仓装置中的位置。
Claims (17)
1.一种外科缝合器械，包括：
框架，其具有主体部分(22)和手柄(26)；
在所述器械的远侧区域中的缝钉固定组件(1，5；24)，所述缝钉固定组件(1，5；24)包括钉仓装置(5；30)和钉砧(1；32)，所述钉仓装置包括至少一排缝钉(72，77)和波浪形的第一组织界面(34)，所述钉砧相对于所述钉仓装置(5；30)可活动并且具有波浪形的第二组织界面(36)，所述第二组织界面能够与所述钉仓装置(5；30)的第一组织界面(34)配合以用于夹紧在其间的组织并使从所述钉仓装置(5；30)离开的缝钉(72，77)的末端(74)成形；
移动装置，其能够相对于所述钉仓装置(5；30)移动所述钉砧(1；32)；
缝钉驱动装置(60；90)，其能够朝着所述钉砧(1；32)并沿着轴向缝钉驱动方向(81)将缝钉(72，77)驱动到所述钉仓装置(5；30)之外，
其中所述缝钉包括一个或多个U形的不对称缝钉(77)，所述缝钉具有两个支脚(78)和连接所述支脚(78)的横向基部(79)，所述支脚带有面向所述钉砧(1；32)的自由尖端(74)，其中所述基部(79)相对于垂直于所述支脚(78)的纵向(81)的平面倾斜，使得所述基部(79)的长度大于其在垂直于所述支脚(78)的纵向(81)的平面(80)上的投影。
2.根据权利要求1所述的外科缝合器械，其中每个缝钉(72；77)被布置在所述钉仓装置(5；30)中，使得所述横向基部(75，79)沿着与所述第一组织界面(34)的相应部分的方向基本平行的方向延伸，缝钉能够由所述缝钉驱动装置(60；90)通过所述相应部分排出，并且所有缝钉(72，77)的支脚(73；78)沿着基本相同的轴向缝钉驱动方向(81)延伸。
3.根据权利要求1或2所述的外科缝合器械，其中所述缝钉驱动装置(60；90)包括推动器(68)，所述推动器具有直接接触所述缝钉(77)的基部(79)的倾斜推动表面(70)，其中所述推动表面(70)相对于垂直于所述缝钉驱动方向(81)的平面(80)倾斜，并且沿着与所述钉仓装置的第一组织界面(58，34)的相应部分的方向平行的方向延伸，缝钉(77)能够由所述缝钉驱动装置(60；90)通过所述相应部分排出。
4.根据权利要求1或2所述的外科缝合器械，其中所述缝钉驱动装置(60；90)包括第二推动器(68)，所述第二推动器具有直接接触所述缝钉(77)的基部(79)的倾斜推动表面(70)，其中所述推动器(68)和所述缝钉(77)与所述第一组织界面(34；58)的一部分相关联，所述第一组织界面(34；58)的一部分与所述缝合器械的“击发”方向非正交。
5.根据权利要求1或2所述的外科缝合器械，其中所述缝钉(77)的横向基部是倾斜基部(79)，所述倾斜基部(79)是基本直的并且与垂直于所述支脚(78)的纵向(81)的所述平面(80)限定在5°至85°之间的角度(α)。
6.根据权利要求1或2所述的外科缝合器械，其中所述缝钉(77)的横向基部是倾斜基部(79)，所述倾斜基部(79)是基本直的并且与垂直于所述支脚(78)的纵向(81)的所述平面(80)限定在20°至70°之间的角度(α)。
7.根据权利要求1或2所述的外科缝合器械，其中所述缝钉(77)的横向基部是倾斜基部(79)，所述倾斜基部(79)是基本直的并且与垂直于所述支脚(78)的纵向(81)的所述平面(80)限定在30°至60°之间的角度(α)。
8.根据权利要求1或2所述的外科缝合器械，其中所述缝钉(77)完全在单一平面内延伸。
9.根据权利要求1或2所述的外科缝合器械，其中所述缝钉(77)的支脚(78)包括细长的基本部分(82)和细长的末梢部分(83)，其中：
所述基本部分(82)彼此稍稍偏离，同时从基部(79)朝着末梢部分(83)延伸；
所述末梢部分(83)基本彼此平行，或者替代地，所述末梢部分(83)从基本部分(82)朝着尖端(74)稍稍会聚。
10.根据权利要求1或2所述的外科缝合器械，其中所述钉仓装置(30)限定多个导槽(84)，所述导槽能够可滑动地容纳所述缝钉(77；72)并且在所述第一组织界面中展开，其中所述钉仓装置(30)的所有导槽(84，76)彼此平行并且沿着相同的轴向缝钉驱动方向(81)延伸。
11.根据权利要求1所述的外科缝合器械，其中所述缝钉驱动装置(60；90)包括第二推动器(68)，所述第二推动器具有能够直接接触U形的起初对称缝钉的基部的倾斜推动表面(70)，其中所述推动表面(70)相对于垂直于所述轴向缝钉驱动方向(81)的平面(80)倾斜，
其中形成在钉砧缝钉成形表面处并且与所述第二推动器(68)协同操作的缝钉成形凹槽(38)相对于缝钉驱动方向(81)偏移，并且能够与所述倾斜推动表面(70)协同操作，以使U形的起初对称缝钉(72)预变形为所述U形的不对称缝钉(77)。
12.一种用于外科缝合器械的外科钉仓装置(5；30)，其中，所述外科钉仓装置(5；30)包括至少一排缝钉(72，77)和波浪形的第一组织界面(34)，所述缝钉包括一个或多个U形的不对称缝钉(77)，所述缝钉具有两个支脚(78)和连接所述支脚(78)的横向基部(79)，所述支脚带有自由尖端(74)，其中所述基部(79)相对于垂直于所述支脚(78)的纵向(81)的平面倾斜，使得所述基部(79)的长度大于其在垂直于所述支脚(78)的纵向(81)的平面(80)上的投影。
13.根据权利要求12所述的外科钉仓装置(5；30)，其中每个缝钉(72；77)被布置在所述钉仓装置(5；30)中，使得所述横向基部(75，79)沿着与所述第一组织界面(34)的相应部分的方向基本平行的方向延伸，缝钉能够由缝钉驱动装置(60；90)通过所述相应部分排出，并且所有缝钉(72，77)的支脚(73；78)沿着基本相同的缝钉驱动方向(81)延伸。
14.根据权利要求12所述的外科钉仓装置(5；30)，其中所述缝钉(77)的横向基部是倾斜基部(79)，所述倾斜基部(79)是基本直的并且与垂直于所述支脚(78)的纵向(81)的所述平面(80)限定在20°至70°之间的角度(α)。
15.根据权利要求12所述的外科钉仓装置(5；30)，其中所述缝钉(77)完全在单一平面内延伸。
16.根据权利要求12所述的外科钉仓装置(5；30)，其中所述缝钉(77)的支脚(78)包括细长的基本部分(82)和细长的末梢部分(83)，其中：
所述基本部分(82)彼此稍稍偏离，同时从基部(79)朝着末梢部分(83)延伸；
所述末梢部分(83)基本彼此平行，或者替代地，所述末梢部分(83)从基本部分(82)朝着尖端(74)稍稍会聚。
17.根据权利要求12所述的外科钉仓装置(5；30)，所述钉仓装置(30)限定多个导槽(84)，所述导槽能够可滑动地容纳所述缝钉(77；72)并且在所述第一组织界面中展开，其中所述钉仓装置(30)的所有导槽(84，76)彼此平行并且沿着相同的轴向缝钉驱动方向(81)延伸。
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| EP06116854A EP1875868B1 (en) | 2006-07-07 | 2006-07-07 | A surgical stapling instrument and a staple cartridge and staple for such an instrument |
| EP06116854.8 | 2006-07-07 | ||
| PCT/EP2007/004489 WO2008003371A1 (en) | 2006-07-07 | 2007-05-21 | A surgical stapling instrument and a staple cartridge and staple for such an instrument |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN101500497A CN101500497A (zh) | 2009-08-05 |
| CN101500497B true CN101500497B (zh) | 2011-08-17 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN2007800298771A Active CN101500497B (zh) | 2006-07-07 | 2007-05-21 | 外科缝合器械以及用于这样的器械的钉仓和缝钉 |
Country Status (8)
| Country | Link |
|---|---|
| US (1) | US8613384B2 (zh) |
| EP (1) | EP1875868B1 (zh) |
| JP (1) | JP5064499B2 (zh) |
| CN (1) | CN101500497B (zh) |
| AT (1) | ATE486527T1 (zh) |
| BR (1) | BRPI0713913B8 (zh) |
| DE (1) | DE602006017990D1 (zh) |
| WO (1) | WO2008003371A1 (zh) |
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| CN2762762Y (zh) * | 2004-06-04 | 2006-03-08 | 许建衡 | 斜切面吻合器 |
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2006
- 2006-07-07 EP EP06116854A patent/EP1875868B1/en active Active
- 2006-07-07 AT AT06116854T patent/ATE486527T1/de not_active IP Right Cessation
- 2006-07-07 DE DE602006017990T patent/DE602006017990D1/de active Active
-
2007
- 2007-05-21 WO PCT/EP2007/004489 patent/WO2008003371A1/en active Application Filing
- 2007-05-21 BR BRPI0713913A patent/BRPI0713913B8/pt active IP Right Grant
- 2007-05-21 CN CN2007800298771A patent/CN101500497B/zh active Active
- 2007-05-21 US US12/307,752 patent/US8613384B2/en active Active
- 2007-05-21 JP JP2009516924A patent/JP5064499B2/ja active Active
Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US2142782A (en) * | 1938-09-15 | 1939-01-03 | Elmon C Gillette | Staple |
| CN2762762Y (zh) * | 2004-06-04 | 2006-03-08 | 许建衡 | 斜切面吻合器 |
Also Published As
| Publication number | Publication date |
|---|---|
| DE602006017990D1 (de) | 2010-12-16 |
| JP5064499B2 (ja) | 2012-10-31 |
| EP1875868A1 (en) | 2008-01-09 |
| US20120325893A1 (en) | 2012-12-27 |
| WO2008003371A1 (en) | 2008-01-10 |
| CN101500497A (zh) | 2009-08-05 |
| BRPI0713913A2 (pt) | 2012-11-06 |
| EP1875868B1 (en) | 2010-11-03 |
| US8613384B2 (en) | 2013-12-24 |
| BRPI0713913B8 (pt) | 2021-06-22 |
| JP2009542266A (ja) | 2009-12-03 |
| BRPI0713913B1 (pt) | 2018-12-26 |
| ATE486527T1 (de) | 2010-11-15 |
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