CN102119010A - 具有切割头的电外科器械钳口结构 - Google Patents
具有切割头的电外科器械钳口结构 Download PDFInfo
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Abstract
本发明提供了一种用于刻划、焊接和离断组织的电外科器械。所述电外科器械包括第一可开闭钳口和第二可开闭钳口以及至少一个刻划电极，所述刻划电极从所述第一可开闭钳口和所述第二可开闭钳口中的至少一个的远端伸出。所述第一可开闭钳口和所述第二可开闭钳口分别包括第一导电性组织接合表面和第二导电性组织接合表面，并且分别包括第一绝缘构件和第二绝缘构件。所述刻划电极连接到所述第一绝缘构件和所述第二绝缘构件中的至少一个。所述至少一个刻划电极能够独立于所述第一可开闭钳口和所述第二可开闭钳口被激活，以使得所述电外科器械能够独立刻划组织和焊接组织。
Description
相关专利申请的交叉引用
本专利申请要求提交于2008年8月7日的美国临时申请No.61/087,001的优先权，该临时申请的内容全文并入本文中。
关于联邦资助研发项目的声明
不适用。
技术领域
本发明涉及医疗器械、系统和方法。更具体地讲，本发明的实施例涉及用于刻划、焊接、密封和离断组织的外科器械、电外科器械和外科钳口结构。
背景技术
已经开发出诸如射频(RF)源、超声源和激光器之类的多种能量源，用于在开放式和腹腔镜式外科手术中将组织块凝结、密封或连接在一起。组织密封的一种优选方式需要将电能施加到捕获的组织上，以在组织内产生密封所需的热效应。已经为此类目的开发了多种单极和双极射频(RF)器械和钳口结构。通常，将射频能量传递到捕获的组织块会升高组织温度，从而至少部分地使组织内的蛋白质变性。在双极射频(RF)钳口结构的典型布置中，相对的第一钳口和第二钳口的每个面都包括电极。RF电流流过相对钳口内的电极之间捕获的整个组织，并使捕获的组织内的许多蛋白质变性。这类蛋白质(包括胶原)被变性为蛋白质混合物，该蛋白质混合物在蛋白质复性时混合和熔合在一起。当处理部位随时间愈合时，这种生物“焊缝”在身体的伤口愈合过程中被重新吸收。组织密封的另一种方式需要将超声能量施加到外科钳口之间捕获的组织上。向捕获的组织施加超声能量同样会升高所捕获组织的温度，从而至少部分地使组织内的蛋白质变性。
诸如肠切开术之类的许多外科手术需要刻划或切开软组织。许多市售的钳口结构可能不适合在同一外科手术过程中既切开软组织又密封不同组织结构。
用于夹入组织块的两个相对侧的当前可用射频钳口通常无法在组织内产生均匀的热效应，不论所捕获的组织是薄还是非常厚。随着组织内射频能量密度的增加，组织表面会变干，并会抑制额外的电阻加热。当组织阻抗升高时，几乎会瞬间发生组织局部脱水和炭化，进而可能导致组织内的密封不均匀。当前可用的典型射频钳口会从被夹入组织开始横向扩散射频密度，导致不希望的旁侧热损坏，从而进一步产生不可取的效果。
由于上述和其他原因，需要能够避免现有装置的至少一些上述缺点的外科器械、电外科器械和外科钳口结构。具体地讲，需要这样的电外科钳口结构，该钳口结构能够进行均匀的高强度组织焊接，减少不可取的热损伤，并且也能够刻划或切开组织以及密封组织结构。
发明内容
本发明的系统和方法的多个实施例涉及在自然组织块内形成热“焊缝”或“熔融”。组织“焊接”和组织“熔融”的替代术语可以在本文中互换使用，以描述对目标组织块进行热处理，从而产生基本上均匀的熔融在一起的组织块，在(例如)焊接的血管内处理后立即表现出较强的破裂强度。这种焊缝的强度尤其可用于(i)在血管离断手术中永久性密封血管；(ii)在切除手术中焊接器官边缘；(iii)焊接需要永久闭合的其他解剖管道；并且也可用于(iv)进行血管吻合、血管闭合或将解剖结构或其一部分连在一起的其他手术。
本文所公开的组织焊接或熔融有别于“凝结”、“止血”和通常涉及减少和阻塞小血管或血管化组织内的血流的其他类似的描述性术语。例如，任何表面施加热能都可能导致凝结或止血，但却不属于本文所用术语“焊接”的范畴。这类表面凝结不会产生能赋予被处理组织任何明显强度的焊缝。
在分子水平上，可能无法充分理解如本文所公开的真正“焊接”组织的现象。然而，作者已经确认可实现组织焊接的参数。如本文所公开的有效“焊缝”由目标组织块内的胶原和其他蛋白质分子的热变性产生瞬时液态或凝胶状蛋白质混合物而形成。在目标组织内提供所选能量密度，可导致胶原和其他蛋白质内的分子内和分子间氢键交联的水热分解。在可以非常短的所选时间内将变性的蛋白质混合物保持所选的水合程度(不脱水)。保持目标组织块处于所选极高程度的机械压缩状态，以确保解链的变性蛋白质彼此接近，以便进行交织和缠结。热驰豫之后，随着再交联和复性的发生，混杂的蛋白质混合物会导致蛋白质缠结，从而产生均匀熔融在一起的块体。
本发明的实施例提供了电外科钳口结构，该结构能够离断捕获在钳口之间的组织，并且能够通过可控地施加RF能量而同时焊接所捕获组织的边缘。该钳口结构可包括刻划元件，该元件可以独立于钳口结构的组织捕获和焊接功能切割或刻划组织。钳口结构可包括相对的第一和第二钳口，这两个钳口都装载正温度系数(PTC)主体，以用于调节递送到被夹入组织的RF能量。
在第一方面，本发明的实施例提供了用于刻划、焊接和离断组织的电外科器械。电外科器械包括第一和第二可开闭钳口以及至少一个刻划电极，所述刻划电极从第一和第二可开闭钳口中的至少一个的远端延伸。第一和第二可开闭钳口分别包括第一和第二导电性组织接合表面，并且分别包括第一和第二绝缘构件。刻划电极连接到第一和第二绝缘构件中的至少一个。
在许多实施例中，所述至少一个刻划电极包括钨丝之类的线材。该线材可至少部分地设置在第一和第二绝缘构件中的至少一个内。线材的远端部分可从第一和第二绝缘构件中的至少一个的远端向远侧延伸。线材的远端部分可环回到第一和第二绝缘构件中的至少一个的远端内并端接于其中。在许多实施例中，所述至少一个刻划电极与第一和第二导电性组织接合表面电绝缘。
在许多实施例中，第一和第二绝缘构件中的至少一个的远端部分分别从第一和第二可开闭钳口的远端向远侧延伸。在许多实施例中，第一和第二绝缘构件由选自包括下列材料的组的至少一种材料制成：氧化锆、部分稳定的氧化锆、氧化铝、氮化硅、氧化铝-氧化铬、羟基磷灰石、其他非导电玻璃材料、其他非导电陶瓷材料、和其他非导电玻璃-陶瓷材料。
在许多实施例中，所述至少一个刻划电极能够被激活，以施加用于刻划组织的电外科能量。在一些实施例中，第一和第二可开闭钳口能够被激活，以施加焊接组织所需电外科能量。所述至少一个刻划电极能够独立于第一和第二可开闭钳口被激活。所施加的电外科能量可包括射频(RF)能量。在许多实施例中，第一和第二导电性组织接合表面连接到射频(RF)能量源。
在许多实施例中，电外科器械还包括近端柄部和细长轴。细长轴具有近端和远端。近端连接到近端柄部，远端连接到第一和第二可开闭钳口。第一和第二可开闭钳口能够围绕细长轴的纵向轴线旋转。
在许多实施例中，电外科器械还包括轴向延伸元件，该元件能够在第一和第二可开闭钳口限定的轴向槽内从回缩位置致动到伸长位置。轴向延伸元件的远端部分具有能够离断组织的切割构件。
在许多实施例中，第一和第二可开闭钳口还分别包括第一和第二正温度系数(PTC)主体。在许多实施例中，第一导电性组织接合表面具有与第二导电性组织接合表面的极性相反的极性。
在许多实施例中，第一导电性组织接合表面包括周边部分和非周边部分。周边部分具有与非周边部分极性相反的极性。在许多实施例中，第二导电性组织接合表面包括周边部分和非周边部分。周边部分具有与非周边部分极性相反的极性。
在另一方面，本发明的实施例提供了利用电外科钳口刻划、焊接和离断目标组织块的方法。用从第一可开闭钳口和第二可开闭钳口中至少一个向远侧延伸的刻划电极刻划邻近目标组织块的组织结构。将目标组织块夹在第一可开闭钳口的第一组织接合表面和第二可开闭钳口的第二组织接合表面之间。将RF能量递送到目标组织块，以焊接目标组织块的至少一部分。该方法还可包括用电外科钳口离断目标组织块。
在许多实施例中，第一可开闭钳口和第二可开闭钳口各自分别包括第一正温度系数(PTC)主体部分和第二正温度系数(PTC)主体部分。向目标组织块递送RF能量可包括利用第一PTC主体部分和第二PTC主体部分中的至少一个减少目标组织块内的组织脱水和炭化。向目标组织块递送RF能量可包括利用第一PTC主体部分和第二PTC主体部分中的至少一个调节电阻加热的进程。
附图说明
本发明的新颖特征在所附权利要求书中特别地加以阐明。然而，引用以下描述并结合附图可以最好地理解本发明本身的构造和操作方法，在这些附图中：
图1为根据本发明实施例的电外科器械的透视图；
图1A为图1的电外科器械的可平移构件的截面图；
图2A示出了图1的电外科器械的工作端，该工作端具有刻划电极，并且处于打开位置；
图2B示出了处于关闭位置的图2A的工作端；
图2C和2D示出了图2A的工作端的截面图；
图2E为图2A的工作端的下钳口的截面图；
图2F为图2A的工作端的串联和并联电路元件的框图；
图3A示出了根据本发明另一个实施例的电外科器械的工作端，该工作端具有两个刻划电极，并且处于打开位置；
图3B示出了处于关闭位置的图3A的工作端；
图3C和3D示出了图3A的工作端的截面图；
图3E示出了图3A的工作端的侧视图；
图4A示出了根据本发明另一个实施例的电外科器械的工作端，该工作端具有两个刻划电极，并且处于打开位置；
图4B示出了处于关闭位置的图4A的工作端；
图4C和43D示出了图4A的工作端的截面图；
图4E示出了图4A的工作端的侧视图。
具体实施方式
在详细阐述本发明之前，应该指出的是，本发明的应用或使用并不局限于附图和具体实施方式中详细示出的部件的构造和布置。可以实施本发明的示例性实施例，或使其结合在其它实施例、变型形式和修改形式中，并且可以通过多种方式实施或执行。此外，除非另外指明，本文所用的术语和表达是为了方便向读者描述本发明的示例性实施例的目的而选择的，并不是为了限制本发明。
此外，应当理解，下述实施例、实施例表达、实例等中的任何一个或多个可与下述其他实施例、实施例表达、实例等中的任何一个或多个结合。
图1示出了根据本发明实施例的电外科器械100。电外科器械100包括近端柄部端105、远端工作端200和设置在二者之间的导入器或轴构件106。工作端200包括具有直或弯曲钳口(上第一钳口120A和下第二钳口120B)的一组可开闭钳口。第一钳口120A和第二钳口120B各自包括沿相应的中部向外设置的细长槽142。第一钳口120A和第二钳口120B通过电缆152内的电线连接到第一电源或RF源145A、第二电源145B和控制器150。利用控制器150可分别启动第一电源145A和第二电源145B。
如图1所示，柄部端105可包括可沿轨迹129拉伸的杠杆臂128。杠杆臂128可连接到设置在导入器或轴构件106内的可平移往复式构件140。柄部可为任何类型的手枪式握把或本领域已知的其他类型的柄部，该柄部被构造为装载用于致动第一钳口120A和第二钳口120B的致动器杠杆、触发器或滑块。导入器或轴构件106具有圆柱形或矩形横截面，并且可包括伸出柄部105的薄壁管状套管。导入器或轴构件106具有延伸穿过其中的孔，以便装载用于致动钳口的致动器机构(例如可平移的往复式构件140)和用于向工作端200的电外科元件输送电能的电线。
工作端200可能够捕获、焊接和离断组织。第一钳口120A和第二钳口120B可以关闭，从而将组织捕获或夹在轴125周围。第一钳口120A和第二钳口120B也可向组织施加压力。如箭头117所示，导入器106可通过(例如)旋转的三重接触器与第一钳口120A和第二钳口120B一起相对于柄部105旋转完整的360°。第一钳口120A和第二钳口120B可保持可开闭，并且可以在旋转过程中被操纵。第一钳口120A和第二钳口120B可通过电缆150内的电线连接到第一电源145A、第二电源145B和控制器150，以充当具有正极(+)和负极(-)的成对的双极电极。
图1A示出了可平移往复式构件或往复式“工字梁”构件140的一部分。柄部105的杠杆臂128可能够致动也充当钳口关闭机构的可平移构件140。例如，当沿轨迹129向近端拉动杠杆臂128时，可以向远端驱动可平移构件140。可平移构件140的远端包括带凸缘的工字梁，该工字梁被构造为在钳口120A和120B的槽142内滑动。可平移构件140在槽142内滑动，以开关第一钳口120A和第二钳口120B。可平移构件140的远端包括上凸缘或“C”形部分140A和下凸缘或“C”形部分140B。凸缘140A和140B分别限定内凸轮表面144A和144B，用于接合第一钳口120A和第二钳口120B的面向外的表面。第一钳口120A和第二钳口120B可利用具有往复式工字梁构件140的凸轮机构在组织上施加非常大的压缩力。凸轮机构可以是本领域熟知的。电外科工作端、钳口闭合机构和电外科能量传递表面在下列美国专利中有所描述，所有这些专利均以引用方式全文并入本文并构成本说明书的一部分：7,381,209、7,354,400、7,311,709、7,220,951、7,189,233、7,186,253、7,186,253、7,169,147、7,125,409、7,112,201、7,087,054、7,083,619、7,070,597、7,041,102、7,011,657、6,929,644、6,926,716、6,913,579、6,905,497、6,802,843、6,770,072、6,656,177、6,533,784和6,500,176。
图2A至2E示出了工作端200的视图。图2A示出了开口构型的工作端200，图2B示出了封闭构型的工作端200。图2C和2D示出了工作端200的截面图。图2E示出了工作端200的下钳口120B的横截面。图2F为图2A的工作端的串联和并联电路元件的框图。
工作端200包括上第一钳口120A和下第二钳口120B。第一钳口120A和第二钳口120B各自具有槽142和组织夹紧元件(例如，设置在第一钳口120A和第二钳口120B内部的齿143)。第一钳口120A包括上第一钳口主体161A，该主体具有上第一面向外的表面162A、上第一能量传递表面175A和上第一中间构件185A。第二钳口120B包括下第二钳口主体161B，该主体具有下第二面向外的表面162B、下第二能量传递表面175B和下第二中间构件185B。第一能量传递表面175A和第二能量传递表面175B均围绕工作端200的远端以“U”形延伸。第一中间构件185A和第二中间构件185B可包括热和/或电绝缘体，例如，氧化锆、部分稳定的氧化锆、氧化铝、氮化硅、氧化铝-氧化铬、羟基磷灰石、其他非导电玻璃材料、其他非导电陶瓷材料、和其他非导电玻璃-陶瓷材料。可平移构件140远端的内凸轮表面144A和144B可能够分别滑动接合第一钳口120A的第一面向外的表面162A和第二钳口120B的第二面向外的表面162B。第一钳口120A和第二钳口120B内的槽142适应往复式构件140的运动，往复式构件可以包括组织切割元件(例如锋利的远侧边缘)。例如，图2B示出了至少部分地穿过槽142推进的可平移构件140的远端。通过推进可平移构件140可以让工作端200由图2A所示开口构型关闭。在图2B所示关闭位置，上第一钳口120A和下第二钳口120B分别限定了第一钳口120A的第一能量传递表面175A和第二钳口120B的第二能量传递表面175B之间的间隙或尺寸D。尺寸D等于约0.0005″至约0.005″，优选地在约0.001″至约0.002″之间。第一能量传递表面175A和第二能量传递表面175的边缘可被倒角，以免切断组织。工作端200还包括刻划电极210。
如图2E所示，工作端200连接到第一电源145A、第二电源145B和控制器150。第一能量传递表面175A和第二能量传递表面175B各自连接到第一电源145A和控制器150。第一能量传递表面175A和第二能量传递表面175B可被构造为接触组织，并向被夹入组织传递能够密封或焊接组织的电外科能量。控制器150可调节第一电源145A传递的电能，继而向第一能量传递表面175A和第二能量传递表面175B传递电外科能量。刻划电极210可连接到第二电源145B和控制器150。控制器150可调节第二电源145B传递的电能，继而向刻划电极210传递电外科能量。刻划电极210继而传递电外科能量以切割或刻划组织。第一电源145A和/或第二电源145B传递的电外科能量可包括射频(RF)能量。
如图2C和2D所示，可通过第一能量传递表面175A和第二能量传递表面175B之间的电流通路177传递电外科能量。可平移构件140可包括绝缘层，用来防止构件140成为传递电流的导电通路。相对的第一能量传递表面175A和第二能量传递表面175B可装载可变电阻正温度系数(PTC)主体或矩阵180A和180B，该主体或矩阵连接到如图2F所示串联和并联电路元件内的第一电源145A和控制器150。第一能量传递表面175A和PTC主体180A可具有负极(-)，而第二能量传递表面175B和PTC主体180B可具有正极(+)。当超过所选跳闸电流时，PTC材料会“跳闸”并变成电阻。第一能量传递表面175A和第二能量传递表面175B可装载下列专利中所公开的任何PTC矩阵和电极元件：名称为“Electrosurgical Jaw Structure for Controlled Energy Delivery”(用于可控能量传递的电外科钳口结构)的美国专利No.6,929,644和名称为“Electrosurgical Jaw Structure for Controlled Energy Delivery”(用于可控能量传递的电外科钳口结构)的美国专利No.6,770,072，这两份专利的公开内容以引用方式全文并入本文中。PTC材料在电外科器械中的用途也在下列专利中有所描述：名称为“Electrosurgical Jaw Structure for Controlled Energy Delivery”(用于可控能量传递的电外科钳口结构)的美国专利No.7,112,201和名称为“Electrosurgical Jaw Structure for Controlled Energy Delivery”(用于可控能量传递的电外科钳口结构)的美国专利No.6,929,622，这两份专利的公开内容以引用方式全文并入本文中。
如图2A、2B和2E所示，第二中间构件185B的一部分可暴露在外或从下钳口主体161B向远端伸出。如图2C、2D和2E所示，刻划电极210设置在下钳口120B的中间材料185B内。刻划电极210能够刻划或切割组织。刻划电极210可包括线材，例如钨丝。中间构件185B的一部分可暴露在外或从钳口主体161B向远侧延伸。刻划电极210从此部分向远侧延伸并环回，以使得刻划电极210的远端211端接于中间材料185B内，并使部分212暴露在外。刻划电极210的暴露部分212能够传递适合刻划或切割组织的电外科能量。由于刻划电极210设置在中间材料185B内，刻划电极210可以与第一能量传递表面175A和第二能量传递表面175B电绝缘。第一能量传递表面175A和第二能量传递表面175B也可单独地(例如通过控制器150)激活，以独立于刻划电极210传递电外科能量，反之亦然。因此，工作端200可以用处于打开或关闭位置的第一钳口120A和第二钳口120B切割和刻划组织，并且不会因第一能量传递表面175A和第二能量传递表面175B而造成不希望的热损伤。作为另外一种选择，刻划电极210可设置在上钳口120A的中间材料185A的凸出部分内，并从凸出部分伸出。
如图2E所示，刻划电极210可以单极模式或双极模式工作。在单极模式下，电外科能量可以经电流通路230从刻划电极210的暴露部分212流向回流垫(return pad)235，以刻划或切割组织。在双极模式下，电外科能量的回流通路可通过钳口主体161A和钳口主体161B提供。如图2E所述，电外科能量可以经电流通路225从刻划电极210的暴露部分212流回到下钳口主体161B，以刻划或切割组织。
图3A至3E示出了工作端300的视图，该工作端和上述工作端200具有许多相同特征。在本发明的另一个实施例中，电外科器械包括工作端300。工作端300包括第一上刻划电极310A和第二下刻划电极310B。图3A示出了开口构型的工作端300，图3B示出了封闭构型的工作端300。图3C和3D示出了工作端300的截面图。图3E示出了工作端300的侧视图。
刻划电极310A和310B能够刻划或切割组织。刻划电极310A和310B可包括线材，例如钨丝。如图3C、3D和3E所示，刻划电极310A设置在上钳口120A的中间材料185A内，刻划电极310B设置在下钳口185B的中间材料185B内。如图3A、3B和3E所示，第一中间构件185A的一部分可以暴露在外，或者从上第一钳口主体161A向远端伸出，第二中间构件185B的一部分可以暴露在外，或者从下第二钳口主体161B向远端伸出。第一刻划电极310A可从第一中间构件185A的暴露部分向远侧延伸并环回，以使得第一刻划电极310A的远端311A端接于第一中间构件185A内，并暴露第一部分312A。第二刻划电极310B可从第二中间构件185B的暴露部分向远侧延伸并循环返回，以使得第二刻划电极310B的远端311B端接于第二中间构件185B内，并暴露第二部分312B。第一暴露部分312A和第二暴露部分312B能够传递适合刻划或切割组织的电外科能量。由于第一刻划电极310A设置在可包括绝缘体的中间材料185A内，第一刻划电极310A与第一能量传递表面175A和第二能量传递表面175B电绝缘。由于第二刻划电极310B设置在可包括绝缘体的中间材料185B内，第二刻划电极310B与第一能量传递表面175A和第二能量传递表面175B电绝缘。第一能量传递表面175A和第二能量传递表面175B也可单独激活，以从第一刻划电极310A和第二刻划电极310B传递电外科能量，反之亦然。因此，工作端300可以用处于打开或关闭位置的钳口120A和120B切割和刻划组织，并且不会因第一能量传递表面175A和第二能量传递表面175B而造成不希望的热损伤。
如图3E所示，工作端300在双极模式下工作。第一刻划电极310A和第二刻划电极310B均连接到第二电源145B。电流可以在第一电极310A的暴露部分312A和第二部分310B的暴露部分312B之间流过，以刻划或切割组织。
图4A至4E示出了工作端400的视图，该工作端与上述工作端200和300具有许多相同特征。在本发明的另一个实施例中，电外科器械包括工作端400，工作端400还包括第一刻划电极410和第二刻划电极411。图4A示出了开口构型的工作端400，图4B示出了封闭构型的工作端400。图4C和4D示出了工作端400的截面图。图4E示出了工作端400的下钳口120B的横截面。
第一刻划电极410和第二刻划电极411能够刻划或切割组织。第一刻划电极410和第二刻划电极411均可包括线材，例如钨丝。如图4C、4D和4E所示，第一刻划电极410和第二刻划电极411设置在下钳口185B的中间材料185B的相对侧面。作为另外一种选择，第一刻划电极410和第二刻划电极411可以设置在上钳口185A的中间材料185A的相对侧面。如图4A、4B和4E所示，第二中间构件185B的一部分可暴露在外或从下第二钳口主体161B伸出。第一刻划电极410可从第二中间构件185B的暴露部分延伸，并从该部分向远端端接。第二刻划电极411可从第二中间构件185B的暴露部分延伸，并从该部分向远端端接。由于第一刻划电极410和第二刻划电极411均设置在可包括绝缘体的中间材料185B内，第一刻划电极410和第二刻划电极411与第一能量传递表面175A和第二能量传递表面175B电绝缘。第一能量传递表面175A和第二能量传递表面175B也可单独地激活，以从第一刻划电极410和第二刻划电极411传递电外科能量，反之亦然。因此，工作端400可以用打开或关闭的第一钳口120A和第二钳口120B切割和刻划组织，并且不会因第一能量传递表面175A和第二能量传递表面175B而造成不希望的热损伤。
如图4E所示，工作端400在双极模式下工作。第一刻划电极410和第二刻划电极411均连接到第二电源145B。电外科能量可经电流通路415在第一刻划电极410的暴露的远端412和第二刻划电极411的暴露的远端413之间传递，以刻划或切割组织。
尽管已经通过描述若干实施例说明了本发明，但申请人并非旨在将所附权利要求书的精神和范围限定或限制到这些细节上。在不脱离本发明的范围的条件下，本领域的技术人员可以进行许多变型、更改和替代。此外，作为另外一种选择，可将与本发明相关的每一个元件的结构描述为用于提供由该元件进行的功能的方式。因此，本发明旨在仅受随附权利要求书的精神和范围的限制。
Claims (25)
1.一种用于刻划、焊接和离断组织的电外科器械，所述电外科器械包括：
第一可开闭钳口和第二可开闭钳口，所述第一可开闭钳口和所述第二可开闭钳口分别包括第一导电性组织接合表面和第二导电性组织接合表面，并且分别包括第一绝缘构件和第二绝缘构件；以及
至少一个刻划电极，所述刻划电极从所述第一可开闭钳口和所述第二可开闭钳口中的至少一个的远端延伸，并且连接到所述第一绝缘构件和所述第二绝缘构件中的至少一个。
2.根据权利要求1所述的电外科器械，其中所述至少一个刻划电极包括线材。
3.根据权利要求2所述的电外科器械，其中所述线材包括钨丝。
4.根据权利要求2所述的电外科器械，其中所述线材至少部分地设置在所述第一绝缘构件和所述第二绝缘构件中的至少一个内。
5.根据权利要求2所述的电外科器械，其中所述线材的远端部分从所述第一绝缘构件和所述第二绝缘构件中的至少一个的远端向远侧延伸。
6.根据权利要求5所述的电外科器械，其中所述线材的所述远端部分回环到所述第一绝缘构件和所述第二绝缘构件中的至少一个的所述远端内，并端接于所述远端内。
7.根据权利要求1所述的电外科器械，其中所述至少一个刻划电极与所述第一导电性组织接合表面和所述第二导电性组织接合表面电绝缘。
8.根据权利要求1所述的电外科器械，其中所述第一绝缘构件和所述第二绝缘构件中的至少一个的远端部分分别从所述第一可开闭钳口和所述第二可开闭钳口的远端向远侧延伸。
9.根据权利要求1所述的电外科器械，其中所述第一绝缘构件和所述第二绝缘构件由选自包括下列材料的组的至少一种材料制成：氧化锆、部分稳定的氧化锆、氧化铝、氮化硅、氧化铝-氧化铬、羟基磷灰石、其他非导电玻璃材料、其他非导电陶瓷材料、和其他非导电玻璃-陶瓷材料。
10.根据权利要求1所述的电外科器械，其中所述至少一个刻划电极能够被激活，以施加用于刻划组织的电外科能量。
11.根据权利要求10所述的电外科器械，其中所述第一可开闭钳口和所述第二可开闭钳口能够被激活，以施加用于焊接组织的电外科能量。
12.根据权利要求11所述的电外科器械，其中所述至少一个刻划电极能够独立于所述第一可开闭钳口和所述第二可开闭钳口被激活。
13.根据权利要求11所述的电外科器械，其中所述施加的电外科能量包括射频(RF)能量。
14.根据权利要求1所述的电外科器械，其中所述第一导电性组织接合表面和所述第二导电性组织接合表面连接到射频(RF)能量源。
15.根据权利要求1所述的电外科器械，还包括：
近端柄部；以及
细长轴，所述细长轴具有近端和远端，所述近端连接到所述近端柄部，所述远端连接到所述第一可开闭钳口和所述第二可开闭钳口，
其中，所述第一可开闭钳口和所述第二可开闭钳口能够围绕所述细长轴的纵向轴线旋转。
16.根据权利要求1所述的电外科器械，还包括轴向延伸元件，所述轴向延伸元件能够在所述第一可开闭钳口和所述第二可开闭钳口限定的轴向槽内从回缩位置致动到伸长位置，所述轴向延伸元件的远端部分具有能够离断组织的切割构件。
17.根据权利要求1所述的电外科器械，其中所述第一可开闭钳口和所述第二可开闭钳口还分别包括第一正温度系数(PTC)主体和第二正温度系数(PTC)主体。
18.根据权利要求1所述的电外科器械，其中所述第一导电性组织接合表面具有与所述第二导电性组织接合表面的极性相反的极性。
19.根据权利要求1所述的电外科器械，其中所述第一导电性组织接合表面包括周边部分和非周边部分，所述周边部分具有与非周边部分的极性相反的极性。
20.根据权利要求1所述的电外科器械，其中所述第二导电性组织接合表面包括周边部分和非周边部分，所述周边部分具有与非周边部分的极性相反的极性。
21.一种使用电外科钳口刻划、焊接和离断目标组织块的方法，所述方法包括：
用从第一可开闭钳口和第二可开闭钳口中至少一个向远侧延伸的刻划电极刻划邻近所述目标组织块的组织结构；
将所述目标组织块分别夹在所述第一可开闭钳口的第一组织接合表面和所述第二可开闭钳口的第二组织接合表面之间；
向所述目标组织块递送RF能量，以焊接所述目标组织块的至少一部分。
22.根据权利要求21所述的方法，还包括用所述电外科钳口离断所述目标组织块。
23.根据权利要求21所述的方法，其中所述第一可开闭钳口和所述第二可开闭钳口各自分别包括第一正温度系数(PTC)主体部分和第二正温度系数(PTC)主体部分。
24.根据权利要求23所述的方法，其中向所述目标组织块递送RF能量包括利用所述第一PTC主体部分和所述第二PTC主体部分中的至少一个减少所述目标组织块内的组织脱水和炭化。
25.根据权利要求23所述的方法，其中向所述目标组织块递送RF能量包括利用所述第一PTC主体部分和所述第二PTC主体部分中的至少一个调节电阻加热的进程。
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| US8700108P | 2008-08-07 | 2008-08-07 | |
| US61/087,001 | 2008-08-07 | ||
| US12/534,935 US20100158895A1 (en) | 2007-04-02 | 2009-08-04 | Methods and compositions for reduction of side effects of therapeutic treatments |
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| CN102119010A true CN102119010A (zh) | 2011-07-06 |
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| US (1) | US20100036370A1 (zh) |
| EP (1) | EP2349042A1 (zh) |
| JP (1) | JP2011530333A (zh) |
| CN (1) | CN102119010A (zh) |
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Also Published As
| Publication number | Publication date |
|---|---|
| WO2010017266A1 (en) | 2010-02-11 |
| US20100036370A1 (en) | 2010-02-11 |
| CA2733133A1 (en) | 2010-02-11 |
| JP2011530333A (ja) | 2011-12-22 |
| EP2349042A1 (en) | 2011-08-03 |
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