CN102695541B - 用于治疗胃肠道损伤的基本为刚性和稳定的腔内外科手术套件 - Google Patents
用于治疗胃肠道损伤的基本为刚性和稳定的腔内外科手术套件 Download PDFInfo
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Abstract
本发明提供了一种用于作用于至少一种解剖学组织的设备和方法的示例性实施方式。提供了包括可膨胀的结构的配置,所述结构(i)具有和/或(ii)形成至少一个开口或工作区,所述解剖学组织通过所述开口或工作区被置于所述结构中。例如,在膨胀前,所述结构具有至少一个部分刚性的部分。附加地或替代地,在部分或完全膨胀后,所述结构能够可控地具有多种形状。而且,所述结构能够可控地为所述工作区提供多种形状和/或多种尺寸。
Description
相关申请的交互引用
本申请要求2009年12月16日提交的美国临时专利申请No.61/287,077的优先权,该申请的全部内容通过引用的方式纳入本文。
技术领域
本发明的示例性实施方式涉及作用于腔内解剖学结构的装置和方法,更具体地涉及用于治疗胃肠道损伤的装置和方法,所述胃肠道损伤一般需要开腹手术治疗。所述装置中的至少一个示例性实施方式能够提供结肠内腔室,并在该腔室内提供多种便于操作的手术工具。例如,这种装置的示例性实施方式能够作为结肠内的微型手术室。
背景技术
目前内窥镜技术可能不利于安全有效地治疗结肠穿孔、大型息肉(large polyps)和肿瘤、以及严重结肠出血。胃肠道出血是常见的潜在危及生命的医学病症,它能够使各种息肉切除(切除息肉)和结肠肿瘤的切除复杂化。当无意中将过度的机械力或过度的能量作用于结肠壁时会发生结肠穿孔。结肠穿孔是危及生命的病症,且目前需要重大紧急手术来封闭结肠穿孔,并预防腹腔内排泄物的污染(fecal contamination)和败血症的产生。
因此,目前许多患有大型息肉、结肠穿孔、结肠出血和其它严重结肠病状的患者不得不经历大手术并忍受重大手术创伤、以及通常疼痛和较长的康复期。目前,当发生结肠穿孔或需要切除大型宽蒂息肉(large wide-based polyps)时,没有安全有效的用于替代腹部大手术的设备和方法。
因此,可能需要解决至少一些上述的缺陷。
2009年10月1日提交的、名称为“可检测的球囊管(Detachable Balloon Catheter”的美国临时专利申请No.61/247,605记载了用于治疗胃肠道穿孔和/或胃肠道出血的设备和方法的示例性实施方式。示例性设备可以包括球囊管(balloon catheter),所述球囊管能够通过压住出血部位控制出血和/或通过封闭腔壁上的开口或封闭穿孔结肠末端来阻止肠道内容物从胃肠道腔进入体腔中。该示例性设备通过使用内窥镜被插入,且当球囊留在目标部位时,可以部分或全部撤回内窥镜。更具体地,所述示例性设备和方法能够有利于阻断结肠出血和封闭结肠穿孔。
Minos Megachannel是大口径柔性增强管(large bore flexible reinforced tube),被设计为可通过标准结肠镜被插入。当移除结肠镜后,所述柔性管可作为将不同仪器插入到结肠中的通道。
此外,常规的内窥镜通常具有一至两个工作通道,所述工作通道不在内窥镜的主体中独立移动。这样一来,当将常规的柔性内窥镜仪器通过所述通道插入到肠腔内时,操作者只能在轴向上(例如,向前和向后移动)和可能一定程度旋转地操纵这些仪器。另外,因为常规仪器仅能从内窥镜的顶端轴向地通向目标损伤并处于内窥镜图像的前面,因而所述常规仪器仅具有有限的功能。
因此,可能需要解决至少一些上述的缺陷。
发明内容
通过提供用于治疗例如胃肠道穿孔、出血、大型息肉的切除、和/或其它重大腔内病状(例如结肠病状)的设备和方法,本发明的示例性实施方式能够满足大部分(如果不是全部的话)的上述需求。
根据本发明的一个示例性实施方式,所述设备能够在腔内例如结肠中作为微型手术室,并为操作者提供具有先进腔内功能复制能力的外科手术套 件。本发明的示例性设备能够提供这种微型腔内手术室、腔室或至少部分闭合(enclosure),以及提供使用能够在所述腔室内、上或周围操作的各种关节连接手术工具(articulating surgical instruments)的可能性。
根据本发明的一个示例性实施方式,在进行标准诊断性结肠镜检查后,可以导入所述示例性装置/设备。可以使用如美国临时专利申请No.61/247,605中记载的示例性球囊导管(balloon guide catheter),或如Minos Megachannel(例如由Minos有限公司生产)的大型腔内通道,以便插入根据本发明的示例性设备。
在本发明的另一个示例性实施方式中,所述装置/设备可以包括多个(例如三个)主要部分,例如,把手、多腔管和可膨胀腔室。
可以使用腔内通道和与所述装置/设备的示例性实施方式相连的关节连接腔内工具。为实现这一目的,所述示例性装置/设备可以包括多腔管。所述多腔管可以包括管腔,所述管腔用于至少两个专用工具或工具通道(tool-channel)、或三个或多个专用工具和/或工具通道。另外,所述多腔管可以包括其它通道(能够用于例如传输空气、水、真空等)。所述示例性装置/设备还可以包括用于窥镜(scope)和照明的通道;以及用于腔室激活的管腔和如本文所述的用于球囊导管的管腔。
根据本发明的又一个示例性实施方式,所述装置/设备还可以包括位于远端的腔室,所述腔室可以在结肠内膨胀到不同的尺寸,从而在目标管腔损伤的附近产生相对大的工作区。示例性装置/设备可以被设计为能够操纵工具和/或工具通道,这样就能够在腔室内或腔室上操作一个或多个这种工具和/或通道的远端,并能够使用多个角度从多个或甚至所有方向上靠近损伤。另外,至少一个工具通道能够容纳大直径的工具,例如专门的内窥镜缝合器(endoscopic stapler)。
在本发明进一步的示例性实施方式中,所述装置/设备可以进一步包括 例如在其近端上或周围的控制把手。所述把手可以以与其它内窥镜的把手相似的方式和/或形状设置,然而进一步包括多个接口(例如工具通道接口、球囊导管接口),控制设备腔室的开启和关闭的专门杠杆(lever)等。
仍根据本发明进一步的示例性实施方式,所述装置/设备可以包括和/或使用特定工具或工具通道。例如,可以利用在设备近端上或周围能够控制的驱动结构,在所有方向和所有自由度内来操作特定工具和/或工具通道的远端。可以通过操纵工具通道操纵(例如,旋转、轴向向前和向后移动、在远端弯曲成各种所需角度)示例性仪器/工具(例如,抓紧器、剪刀、解剖器、其它),所述示例性仪器/工具能够被插入到专门的工具或工具通道中。
在本发明的进一步示例性实施方式中,所述装置/设备可以使得所述装置/工具除了能够轴向和旋转地移动之外,还能够横向移动和/或多方向地移动。由于所述示例性工具通道可以独立于主要内窥镜和其它工具通道而被操纵,因此所述仪器/工具能够从不同的甚至可能是无限制的方向靠近损伤。例如,当内窥镜仪器/工具从涉及主要纵轴的侧面靠近损伤时(因此不会遮挡内窥镜图像),可在腹腔镜检查中实现已知的所谓的“三角测量(tri-angulation)”。三角测量是用来实现内窥镜装置/设备功能性和安全性改善的优选技术。这种示例性方法学能够模拟已经成熟的外科手术室环境的功能。所述示例性工具通道能够从多腔管的工作接口处通入管腔中和/或所述示例性工具通道至少部分预固定到相连的可膨胀腔室的元件上。所述示例性工具通道还能够直接通入到身体管腔(例如,肠腔)、腔室空间,和/或起初沿着腔室的元件通入,然后进一步进入身体管腔或腔室空间内。
另外,还根据本发明的另一个示例性实施方式,所述装置/设备、替代地为工具通道或与工具通道的结合,可以使用传统的和/或带有至少两个自由度的关节连接的仪器/工具。
另外,根据本发明的进一步示例性实施方式,提供在身体管腔(例如结 肠)中使用所述示例性装置/设备的方法。例如,使用这种示例性方法,可以进行标准结肠镜检查并确认可能不能使用标准内窥镜技术治疗的损伤。可以插入球囊导管,使球囊充气膨胀并移除标准结肠镜(球囊导管和膨胀的球囊留在原处)。球囊导管可被用作引导丝,以便于插入所述示例性装置/设备。通过球囊导管插入所述示例性装置/设备,例如,直到腔室接近损伤。展开腔室并将其调整至特定的尺寸。在手术过程中可以根据需要重新调整腔室的尺寸。进一步地,可以使用设置的抽吸管清洁手术部位。进一步地,可以膨胀近端球囊、远端球囊或同时膨胀近端和远端球囊以隔离治疗部位。可以插入工具通道,随后或同时将所述仪器/工具插入到所述工具通道中。还可以操纵所述工具通道来优化和促进仪器/工具靠近损伤。进一步地,可以进行手术,例如封闭结肠穿孔、切除大型结肠息肉或肿瘤、阻断出血、终止憩室炎(closing diverticuli)、切除阑尾、治疗其它体腔损伤等。
进一步地,提供了作用于至少一个解剖学组织的设备和方法的示例性实施方式。提供了一种包括可膨胀结构的配置(configuration),所述结构(i)具有和/或(ii)形成至少一个开口或工作区,解剖学组织通过所述开口或工作区被置于所述结构中。例如,在膨胀前,所述结构可以具有至少一个部分刚性的部分。另外,或作为另一种选择,在部分或完全膨胀后,所述结构可控地具有多种形状。此外,所述结构可以可控地为工作区提供多种形状和/或多种尺寸。
仍根据本发明的另一个示例性实施方式,在所述结构膨胀前,所述结构具有至少一个可膨胀形成可以为不对称的非圆柱形工作区的部分刚性的部分。进一步地,可以包括内窥镜装置,所述内窥镜装置设置在所述工作区内,并可以包括另外的配置,所述另外的配置有利于工作区内的内窥镜装置顶端部分的关节连接。所述另外的配置可以包括有利于顶端部分在工作区内移动的机械弯曲臂,从而有利于工作区内至少一个目标的成像。还可以设置与所 述结构连接的装置,所述装置提供(i)至少一个管腔和/或(ii)至少一个仪器以便它们穿过到达工作区。例如,装置顶端和结构远端部分(离装置最远)之间的距离是可控的,从而可以调整工作区的形状和/或尺寸。
仍在本发明的另一个示例性实施方式中,所述结构完全或部分膨胀后,所述结构可以可控地具有多种形状。另外,所述结构可以可控地为工作区提供多种形状和/或多种尺寸。所述结构可以具有膨胀部分和未膨胀部分,从所述设备的延伸轴至所述膨胀部分最高点的第一距离可以不同于从所述设备的延伸轴至非膨胀部分的距离。例如,第一距离可能大于第二距离。可以控制所述结构来在保持第二距离几乎不变时调整第一距离。进一步地,在非膨胀状态时,所述配置可以控制成在多个方向上提供关节连接。
根据本发明的进一步示例性实施方式,在距所述配置和解剖学结构有一定距离的地方可以设置有第一装置。另外,在所述第一装置和所述配置之间可以设置有第二装置,所述第二装置具有至少一个与所述第一装置连接的管腔。进一步地,还可以设置有第三装置,所述第三装置设计为可以穿过管腔在解剖学结构上或附近移动,还可以设计为设置在所述结构中。所述管腔可以包括多通道管,所述结构可被设计为可移动穿过所述多通道管并与所述多通道管刚性连接,以限制或减少所述结构相对于多通道管的移动。在配置内或其附近可以设置有至少一个可移动的、并可移动地穿过所述多通道管的照相机和照明装置。在所述结构内或附近可以设置有至少一个可移动的、并可移动地穿过所述多通道管的真空导管和/或注入导管。
在一个示例性的实施方式中,所述管腔可以包括在其中可移动的管通道和/或工具通道。所述工具通道可以为轴向可移动的、可旋转的和/或可弯曲的,并可以包括至少一个被设置成使所述工具通道弯曲的金属丝。所述工具通道的远端可被设置成能够到达结构内部或附近的任何点。所述工具通道可以包括至少一个能够以至少一个方向和至少一个角度(在0°-180°之间)弯 曲所述管或工具通道的金属丝。例如,所述工作通道和所述结构之间的距离可以通过移动工作通道中的至少一个金属丝以使其朝向和/或远离所述结构来控制。在所述配置内部或附近可以设置有内窥镜,所述内窥镜可移动地穿过所述多通道管从而到达工作区。所述内窥镜可以包括设置在柔性柄(flexible shaft)上以使组织的至少一部分成像的图像传感器。
仍根据本发明的进一步示例性实施方式,所述结构具有至少一个柔性条或至少一个金属丝和/或两个或多个柔性条或金属丝。至少其中一个条或金属丝可以具有预设的形状以为所述工作区提供所需的几何形状。另外,可以设置有至少一个球囊或两个或多个球囊。至少其中一个球囊可以是不对称形状和/或对称形状的。所述球囊可以设置在所述结构的近端。根据一个示例性变体,可以设置有第一球囊和第二球囊,其中所述第一球囊设置在相对于结构的远端,所述第二球囊设置在相对于结构的近端。所述结构可以包括金属丝和/或网丝(mesh)。在膨胀前,这种金属丝和/或网丝可以具有(i)至少一个部分刚性的部分,(ii)在部分或完全膨胀后,能够可控地具有多种形状,和/或(iii)能够可控地为所述工作区提供多种形状和/或多种尺寸。
当结合随附的权利要求,通过阅读下文对本发明示例性实施方式的具体描述时,本发明的示例性实施方式的上述和其它的目的、特征和优点将会变得显而易见。
附图说明
从以下结合显示本发明说明性实施方式的附图的详细描述中,本发明其他的目的、特征和优点将会更显而易见,附图中:
图1a和1b是本发明装置/设备的示例性实施方式的示意性横截面图,包括一个多腔挤出管,和在一个大管中的多个管;
图2a是根据本发明的包括处于开放状态的镍钛合金(nitinol)条形腔室 的装置/设备的示例性实施方式的透视图;
图2b是具有由处于闭合状态的柔性条形成的腔室的图2a的装置/设备的透视图;
图2c是具有由处于另一状态的柔性条所形成的腔室的图2a的装置/设备的侧视图;
图2d是根据本发明一个示例性实施方式的具有覆盖了处于闭合状态的腔室的外套管(overtube)的图2a的装置/设备的侧视图;
图2e是根据本发明另一个示例性实施方式的具有设置在其中一个工作通道上并有利于形成视野范围的窥镜的图2a的装置/设备的侧视图;
图3是根据本发明包括由两个金属条构成的腔室的装置/设备的另一个示例性实施方式的透视图;
图4是根据本发明包括由两个不对称球囊构成的腔室的装置/设备的示例性实施方式的横截面侧视图;
图5是根据本发明包括由一个不对称球囊和球囊导管构成的腔室的装置/设备的另一个示例性实施方式的透视图;
图6是根据本发明包括由金属丝编带(metal wires braid)构成的腔室的装置/设备的另一个示例性实施方式的透视图;
图7是根据本发明包括两侧具有两个封闭球囊的镍钛合金条腔室的装置/设备的又一个示例性实施方式的另一实例的透视图;
图8是根据本发明包括带有照相机的腔室的装置/设备的一个示例性实施方式的另一实例的侧视图,;
图9a是根据本发明另一个示例性实施方式的包括特定把手的装置/设备的右侧透视图;
图9b是图9a中示例性装置/设备的左侧透视图;
图10是根据本发明包括真空导管的装置/设备的另一个示例性实施方式 的另一实例的透视图;
图11是根据本发明包括工具通道的装置/设备的另一个示例性实施方式的另一实例的透视图,;
图12仍是根据本发明包括工具通道升降器的装置/设备的另一个示例性实施方式的优选实施方式的不同视图;以及
图13是根据本发明包括腔室内的工具通道的装置/设备的另一个示例性实施方式的另一实例的透视图。
整个附图中,除非另有说明,均使用相同的附图标记和符号表示相同的实施方式所示的特征、元件、部件或部分。而且,当参照附图详细描述本发明的目的时,关于说明性的实施方式也如此。应当理解的是,在不背离后附权利要求所限定的本发明的实际范围和精神的前提下,可以对所述示例性实施方式进行改变和修饰。
具体实施方式
根据本发明的一个示例性实施方式,提供了用于治疗例如与身体管腔或/和体腔(cavities)相关的病症(例如胃肠道病症,包括但不限于胃肠道穿孔、出血、大型息肉或/和肿瘤、憩室炎、阑尾炎和其它病症)的设备、装置和方法。
根据本发明装置/设备的示例性实施方式可以提供不同的功能,和外科手术室所提供的手术功能相同和/或相类似,因此,相当于管腔(如,身体的)如结肠内的微型手术室,并可以替代如开腹手术的大手术。
例如,如图2a和2b所示,根据本发明装置/设备1的示例性实施方式提供了腔内室,所述腔内室可以是至少部分闭合的,如腔内结肠或结肠内腔室/闭合空间(enclosure),腔室10内包括各种便于操作的仪器和/或工具11。如在标准结肠镜检查过程中确认到一个或多个相关损伤后,可插入示例性装 置/设备1。可以使用如2009年10月1日提交的美国临时专利申请No.61/247,605中记载的特定球囊导管4或例如Minos有限公司生产的Mega-channel来促进示例性装置/设备1的插入。
根据本发明的某个示例性实施方式,装置/设备1可以是特别设计的内窥镜,如结肠镜。如图9a和9b所示,根据某个示例性实施方式,所述装置/设备1可以包括例如:示例性把手20(见图9a和9b)、示例性多腔管30(见图1a、1b、3、7、8和13)和示例性可膨胀的腔室10(见图5、7、10和13)。另外,所述装置/设备1可以包括标准的和特殊的示例性仪器/工具11(见图8、12和13)和/或示例性工具通道(见图13)。
如上所述,所述示例性装置/设备1可以包括多腔管30。所述示例性的多腔管30可以由具有多个管腔的单挤出聚合物管(single extrusion polymer tube)31构成(见图1a),和/或在标准内窥镜设备配置中由一些具有不同尺寸的单或多腔管32构成,所述多腔管32被单个的、较大的、柔性的管33封闭(见图1b)。外部和内部管可以是本领域所熟知的简单聚合物管和/或加强管或编织管(braided tubes)。外部管33可以具有足够大的直径以容纳所述示例性装置/设备1所提供的所有内部管32。如图1b的示例性实施方式所示,示例性多腔管30可以包括至少一个管腔,以及例如可能包括用于2至4个或更多示例性仪器/工具11和/或工具通道40的2至4个或更多的管腔,和可能的附加管腔,例如,用于注入空气的管腔34、用于注入水的管腔35、真空管腔36、用于布线(wiring)和/或照相机和照明纤维(fiber)的管腔37、用于球囊导管的管腔4、用于腔室膨胀控制的管腔38和/或用于近端球囊充气的管腔39。
例如,根据本发明具体的示例性实施方式,所述装置/设备1包括能够在结肠内膨胀到不同尺寸的远端腔室10,由此在待治疗的损伤附近可能产生相对大或足够的工作区。如图3、7、8和13所示,示例性腔室10能够提供 用于操作多种工具和/或工具通道的空间,这样多个工具就能够从各个侧面和方向上靠近损伤。示例性多腔管30(如直径为10mm-40mm)能够容纳至少一个工具通道,所述工具通道又可以容纳如非标准仪器,例如,内窥镜缝合器,它们都具有足够的尺寸以用于特定的目的。
根据本发明的一个示例性实施方式,如图2a-2e和3所示,示例性腔室10由至少一个和可能两个或多个柔性金属条、纤维或金属丝12构成,它们可由柔性材料如镍钛合金制成。所述示例性条、纤维或金属丝还可以由其它材料制成,包括但不局限于外科手术塑料或其它材料。当腔室10(提供工作区)处于非展开的状态时(见图2a和2b),所述示例性条、纤维或金属丝12大体上是直的(或根据需要在操纵设备穿过管腔的过程中轻微适度地弯曲),且如图2b、2c、2e和3所示,当所述示例性条、纤维或金属丝12被把手20上的控制杠杆23驱动时基本上是弯曲的,由此在结肠内部扩大腔室10并创造较大的工作区。例如,如图2a-2e、3、9a和9b所示,可以用管19推或拉所述示例性条、纤维或金属丝12,所述管子19可以通过拉和/或推把手20上的管19近端的杠杆23在管腔38中滑动。进一步地,可以将导管4插入所述管19内。示例性条12可以用柔软的聚合物覆盖物覆盖,以避免可能的结肠内组织的损坏。
根据本发明的一个示例性实施方式,如图2a-2e所示,通过拉所述示例性条、纤维或金属丝12可以使腔室10转向,或当从把手30向前推所述示例性条、纤维或金属丝12时可以使腔室10被打开。如本文进一步的详细描述和如图8所示,以这种方式,所述示例性条、纤维或金属丝12在腔室30内扩大了工作区,从而有利于通过由把手30操纵的其它仪器/工具11将解剖学结构推进腔室10内。
进一步的,如图2c和2e所示,所述示例性条、纤维或金属丝12可由保护性覆盖物70覆盖,以便当驱动所述示例性条、纤维或金属丝12来扩大 腔室10(即,使所述示例性条、纤维或金属丝12推动周围的组织)时,能降低由其引起的损坏。如图2d所示,所述装置/设备1还可以包括外套管65,所述外套管65可以被推至所述装置/设备1的前面,以覆盖收缩的腔室10(如,便于插入和移除和容纳试样),还可以被推向后面以为扩大腔室10做准备。图2e显示了带有窥镜60(包括照相机和至少一个光照源)的图2a的装置/设备1的视图,所述窥镜60设置在其中一个工作通道40上,并有利于视野(field of view)54定位和推动所述示例性装置/设备1。
当仪器1到达期望的身体部位时,所述窥镜60可以例如通过工作通道40在腔室10内伸缩,以便在腔室10的里面和/或附近成像。根据本发明的另一个示例性实施方式,可通过一个或多个工作通道40将关节连接的窥镜(它与窥镜60具有相似的功能)设置在腔室10内。所述关节连接的窥镜被设置为可以照明和/或提供腔室10里面和/或附近的解剖学结构和工具的图像。所述关节连接的窥镜可具有远端部分,所述远端部分可以旋转360°且能够弯曲以提供其终端,从而能以任意角度对腔室10里面和/或附近的解剖学结构和工具的任意部分进行照明和成像。
在本发明的另一个示例性实施方式中,如图7所示,所述条12可以在近端与由固体材料制成的第一帽状物14连接。所述第一帽状物14可以具有用于大多数或所有的管腔32的多个孔。所述条12还可以在远端与第二帽状物15连接,所述第二帽状物15的直径比第一帽状物14的直径小,以使大型试样如息肉进入腔室10区域中。远端的第二帽状物15包括用于插入球囊导管4的孔。附加地或替代地,如图4中的示例性实施方式所示,所述示例性腔室10可以由两个不对称的球囊5、16构成。例如,当充气膨胀时,所述球囊5、16可以为腔室10和示例性仪器/工具11创造空间。附加地或替代地,如图5所示,使用近端球囊16和远端球囊5(通过与球囊导管4的连接物彼此连接)提供示例性腔室10。进一步附加地或替代地,如图6所示,通 过在需要的位置具有开口18的金属丝编织网(braided metal wire net)17提供示例性腔室10。
在本发明的另一个示例性实施方式中,至少一个和可能两个或多个球囊可以与腔室10一起使用,所述腔室10由可弯曲材料(如金属)构成的条12制成。所述示例性球囊5、16可以协助腔室10来封闭和/或隔离结肠的其余部位,由此可以减少和/或阻止液体和固体流入和流出腔室10,而示例性条12可以提供基本刚性和稳定的工作区以便于损伤的治疗。例如,如图7所示,第一对称或不对称球囊16可以设置在腔室10或条12位置的近端。第二球囊5可以设置在条12的远端位置。另外,所述第二球囊5可以与导管4连接。
仍根据本发明的另一个示例性实施方式,所述装置/设备1可以包括至少一个照相机和照明设备来为关心的部位提供充足的光照。例如,照相机和照明元件可以是可移动的或固定在所述装置/设备1上(如固定在腔室10上)。在图2e所示的一个示例性实施方式中,可以使用窥镜/前置照相机50来帮助装置/设备1插入到结肠中。参照图8,例如,可以设置至少一个、两个或多个附加的并可能是固定的照相机51以便在损伤处捕获图像。照相机51的示例性视野54可以重叠,且当一个或多个仪器/工具阻碍或对其中一个照相机的视野产生不利影响时,这种重叠可以帮助成像。例如,可以使用不同方式提供照明,如通过LEDs 52、53。示例性前置LEDs 52可用于前置照相机50,腔室内LEDs 53可用于在腔室10内或在腔室10上照明。附加地或替代地,可以使用具有远端可弯曲部分的常规柔性内窥镜代替或与固定照相机51一起使用并通过LEDs 52、53进行照明。
如图9a和9b所示,根据本发明的进一步示例性实施方式,所述示例性装置/设备1可以包括位于近端上或周围的控制把手20。示例性把手20可以与其他常规内窥镜把手具有相似的形状和结构,而且与标准内窥镜相比可能 具有附加的通道接口和驱动器。例如,位于把手20上的接口可以包括至少一个和可能2-4个或甚至多个用于工具通道21、球囊导管接口22和特定的杠杆23的接口,从而控制腔室10的开启和关闭。附加的接口可以包括但不限于用于近端球囊充气的鲁尔接口(luer port)24、和真空导管25或冲洗导管的接口26。把手20可以包括用于吹入空气、注水和真空激活(vacuum activation)的开关27、28,以及在前面和内部位置之间用于开关照相机的开关(未显示)。
如图10所示,仍根据本发明的另一个示例性实施方式,所述示例性装置/设备1包括带有弯曲顶端25的真空导管,通过真空接口26插入到真空管腔36中。所述真空导管可以独立使用(如本文所述),和/或可将其插入到工具通道40中并转向。进一步地,可以操纵所述真空导管到达腔室10里面和周围的所有或大多数部位,因此,提供了从腔室10及其周围去除液体和固体的通路。在本发明的另一个示例性实施方式中,腔室10可以包括可在杠杆23上进行驱动的可弯曲和可操纵的部分,当拉动它时,仪器1被关节连接,当推动它时,腔室10被打开(或尺寸增大)。由此可以有利于示例性装置/设备1在结肠内的移动。根据本发明的进一步示例性实施方式,可以设置一个锁定结构,所述锁定结构可以例如旋转一次或多次(如逆时针方向或反时针方向)从而锁定杠杆23。
仍根据本发明的另一个示例性实施方式,如图11所示,所述示例性装置/设备1可以包括仪器/工具11和/或工具通道40。如图12所示,当示例性仪器/工具11插入到工具通道40时,无论相关工具通道40的位置和形状是否发生改变,其远端41均可改变仪器/工具11的位置和/或形状,例如进行旋转、轴向移动和/或以所需角度弯曲。所述工具通道40可以在本发明的示例性装置/设备的近端上或周围被驱动和操纵。所述工具通道40(例如,它们的远端41)的可操作性提供和/或促进了从多方向和多角度靠近目标损伤。
例如,所述工具通道40可以包括至少一个,优选两个、三个或多个管腔管道42,所述管腔管道42可以由聚合物制成,可能具有高的扭矩力(torque-ability)、低摩擦性,在它们的远端上或周围与具有“升降器”43的附加部分41连接。可以用其它材料加强示例性聚合物管道42以改变它的/它们的结构或/和功能特性。升降器43可以是柔性可弯曲部分,例如,由镍钛合金激光切管(laser cut nitinol tube)44构成,和/或使用如一个或两个金属丝45驱动(例如弯曲)。仪器/工具11可以插入到第一(例如相对大的)管道42的管腔中,金属丝45可以插入到第二(例如相对小的)管道42的管腔中。
如图13所示,工具通道管道42独立地或同时地轴向移动(例如,在推、拉的方向上)、旋转和借助升降器43弯曲的能力有助于仪器/工具11或/和工具通道40到达腔室10里面和周围的任何点,而且可以在工作区内提供可能无限制的仪器自由移动的范围。例如,如图11所示,所述工具通道40可以包括一个或多个把手46,所述把手在管道42的邻近侧端上或周围与管道42连接,并用来操纵升降器43,且使用接口47以用于示例性仪器/工具11的插入。如图12所示,示例性工具通道把手46可以包括滑块或按钮(knob)48,以用于驱动(例如拉和释放)金属丝45。任何标准工具可以和示例性工具通道40一起使用。附加地或替代地,可以使用带有可操作远端(例如具有至少二个自由度)的关节连接工具。
还根据本发明进一步的示例性实施方式,提供了实施根据本发明示例性装置/设备1的方法。可以使用的所述示例性方法如下:
i.进行标准结肠镜检查,并确认可能不能用标准内窥镜技术治疗的损伤;
ii.插入球囊导管,使球囊充气膨胀并移除标准结肠镜(球囊导管和膨胀的球囊留在原处)。球囊导管可作为导丝使用,从而有利于示例性装置/设 备1的插入;
iii.沿球囊导管插入示例性装置/设备1,直到腔室到达所述损伤附近;
iv.展开和调整示例性装置/设备1的腔室10至优选的尺寸。在手术过程中可根据需要重新调整腔室10;
v.使用提供的抽吸管清洁手术部位。如果需要的话,膨胀近端球囊、远端球囊或同时膨胀近端和远端球囊,以隔离治疗部位;
vi.插入工具通道;
vii.将仪器/工具插入到工具通道中。操纵工具通道以优化和促进仪器/工具靠近损伤;
viii.进行手术,例如,封闭结肠穿孔、切除大型结肠息肉或肿瘤、阻断出血、终止憩室炎、切除阑尾、治疗其它体腔损伤。
上文仅仅描述了本发明的原理。根据本文的教导,对所述实施方式进行各种修改和改变对本领域技术人员而言是显而易见的。例如可使用不只一个所述的示例性装置、放射疗法(radiations)和/或系统来实施本发明的示例性实施方式。因此能够理解的是,本领域技术人员能够设计许多系统、装置和方法,尽管体现了本发明原理的这些系统、装置和方法并未在本文中详细显示或描述,但是仍在本发明的思想和范围内。另外,虽然现有技术的知识并没有通过引用的方式明确纳入本文,但也将其整体纳入本文。本文所引用的出版物的全部内容均通过引用的方式纳入本文。
Claims (23)
1.一种用于作用于至少一个解剖学组织的设备,该设备包括:
近端把手、多腔管和远端腔室,所述远端腔室可膨胀并具有或形成开口或工作区,所述开口或工作区具有多种形状和/或尺寸,
其特征在于,至少一个工具通道容纳于所述多腔管中,所述工具通道的远端通过在所述设备的近端上或周围的驱动机构可操作,所述设备还包括适于彼此独立地操纵的多个工具通道。
2.根据权利要求1所述的设备,其特征在于,所述把手包括用于控制所述腔室的开启和关闭的杠杆。
3.根据权利要求1或2所述的设备,其特征在于,所述工具通道可从所述多腔管的工作接口通入管腔中。
4.根据权利要求1或2所述的设备,其特征在于,所述工具通道包括至少一个被设置成使所述工具通道弯曲的金属丝。
5.根据权利要求4所述的设备,其特征在于,所述工具通道包括一个或多个把手,所述一个或多个把手在所述工具通道的管道的邻近侧或周围与所述管道连接,用于操纵形成所述远端的一部分的升降器,以使用所述多腔管中的接口插入仪器或工具。
6.根据权利要求5所述的设备,其特征在于,所述工具通道包括滑块或按钮,以用于驱动所述金属丝。
7.根据权利要求1或2所述的设备,其特征在于,所述腔室具有两个或更多个柔性条或金属丝。
8.根据权利要求7所述的设备,其特征在于,所述柔性条或金属丝由保护性覆盖物部分覆盖。
9.根据权利要求7所述的设备,其特征在于,所述柔性条在近端与第一帽状物连接并在远端与第二帽状物连接。
10.根据权利要求9所述的设备,其特征在于,所述第二帽状物的直径小于所述第一帽状物的直径。
11.根据权利要求1或2所述的设备,其特征在于,所述腔室在膨胀前具有至少一个部分刚性的部分。
12.根据权利要求1或2所述的设备,其特征在于,所述工作区是不对称的。
13.根据权利要求1或2所述的设备,其特征在于,该设备与穿过一个或多个工具通道的关节连接的内窥镜结合。
14.根据权利要求1或2所述的设备,其特征在于,该设备与多个仪器/工具结合,所述仪器/工具用于穿过一个或多个工具通道,并且所述工具通道的操纵移动所述仪器/工具的远端。
15.根据权利要求1或2所述的设备,其特征在于,第一工具通道可在所述多腔管的管腔中移动,以引导第一仪器/工具穿过第一工具通道并进入所述腔室,第二工具通道可在所述多腔管的另一管腔中移动,以引导第二仪器/工具穿过第二工具通道并进入所述腔室。
16.根据权利要求1或2所述的设备,其特征在于,所述腔室可调整,以为所述工作区提供多种尺寸。
17.一种腔内设备,其可插入患者的身体管腔中,以增大管腔内的工作区,所述设备包括把手、具有第一管腔和第二管腔的管道、位于远端部分处的腔室,所述腔室可在未膨胀配置和膨胀配置之间活动,以提供部分闭合空间,所述第一管腔和所述第二管腔中的每一个被设置成接收腔内仪器穿过,从而使得所述仪器的远端可在所述腔室内定位和操纵,以在所述腔室内进行手术过程,所述腔室可膨胀,以增大所述身体管腔中的工作区,从而使得能够利用可插入穿过相应的第一管腔和第二管腔的腔内仪器进行手术过程,所述第一管腔和所述第二管腔可在膨胀的腔室中定向,以沿着相对于所述设备的纵轴的横向以及从不同方向接近组织结构,所述设备还包括第三管腔,以接收腔内仪器,从而使得所述腔内仪器提供所述腔室内的成像,所述仪器彼此独立地被操纵。
18.根据权利要求17所述的腔内设备,其特征在于,所述腔室包括可在收缩位置和膨胀位置之间移动的多个部件。
19.根据权利要求17或18所述的腔内设备,其特征在于,还包括可从所述设备的近端部分驱动以在收缩位置和膨胀位置之间移动所述腔室的控制部件。
20.根据权利要求18所述的腔内设备,其特征在于,还包括定位于所述腔室的所述多个部件上方以在插入期间保护所述身体管腔的覆盖物。
21.根据权利要求17或18所述的腔内设备,其特征在于,所述腔室包括至少一个部分刚性的部分。
22.根据权利要求17或18所述的腔内设备,其特征在于,所述腔室可沿横向向着所述设备的纵轴的仅仅一侧移动。
23.根据权利要求18所述的腔内设备,其特征在于,所述多个部件在近端处和远端处与帽状物连接。
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CN201080057201.5A Active CN102695541B (zh) | 2009-12-16 | 2010-12-16 | 用于治疗胃肠道损伤的基本为刚性和稳定的腔内外科手术套件 |
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JP (1) | JP5852008B2 (zh) |
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CA (1) | CA2783252A1 (zh) |
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CN110584745B (zh) | 2014-09-19 | 2023-07-11 | 恩多巧爱思股份有限公司 | 将网附接到外科勒除器装置的带涂层的环构件的方法 |
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