CN103260531B - 具有可拆卸可枢转夹爪的医疗装置 - Google Patents
具有可拆卸可枢转夹爪的医疗装置 Download PDFInfo
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Abstract
本发明提供了医疗系统和装置以用于接合组织(T),例如用于夹住组织(T)、闭合穿孔或进行止血。通常,所述医疗系统(20)包括壳体(42)、可相对于所述壳体(42)旋转的第一夹爪(44)和第二夹爪(46)、驱动器(48)和细长驱动线(22)。所述细长驱动线(22)可从驱动器(48)、第一夹爪(44)和第二夹爪(46)以及壳体(42)分离,所述驱动器、第一夹爪和第二夹爪和壳体被留在活体内而与组织(T)接合。
Description
背景技术
通常,可通过内窥镜将夹子(clip)引入体腔中,以抓握体腔的活组织以便止血、标记和/或结扎。这种夹子常称为外科小夹钳、内窥镜夹、止血夹和血管夹。另外,夹子如今用于与胃肠道出血相关的多种应用中,如消化性溃疡、食管贲门黏膜撕裂症、Dieulafoy病变、血管瘤、乳头切开术后出血和具有活动性出血的小静脉曲张。夹子也已试图用于闭合胃中的穿孔。
胃肠道出血为略为常见和严重的病症,如果不治疗,其常常是致命的。该问题已促使开发出多种内窥镜治疗方式以实现止血,如注射硬化剂和接触热凝技术。尽管这些方式常常是有效的,但许多患者继续出血,因此矫形手术变得必要。由于手术为与高发病率和许多其他不利的副作用相关的侵入性技术,需要有效性高、侵入性低的程序。
诸如夹子的机械止血装置已在身体的各个部分中使用,包括胃肠道应用。然而,与常规止血装置和夹子相关的问题之一是许多装置没有强到足以产生永久止血。此外,夹子也已试图用于闭合胃或胃肠道结构中的穿孔,但不幸地,常规夹子遭受放置困难和抓握组织的量有限的问题,从而有可能导致不完全的闭合。
发明内容
本发明可包括各种组合的如下方面的任意者,也可包括在如下所撰写说明书或在附图中描述的任何其他方面。
在第一方面,提供了一种用于接合组织的医疗装置,所述医疗装置包括壳体、第一夹爪和第二夹爪、夹爪销以及驱动器。所述壳体限定了在壳体的近端和远端之间延伸的内部通道和纵向轴线。所述壳体也限定了沿着所述内部通道的夹爪引导表面,所述夹爪引导表面具有远端。所述第一夹爪和第二夹爪具有可滑动且可枢转地连接至所述壳体的近端,并且可滑动地接收于所述内部通道内,以在伸出位置与回缩位置之间沿着所述夹爪引导表面纵向移动。所述夹爪销延伸通过所述第一夹爪和第二夹爪两者的近端,并接合所述壳体的夹爪引导表面。所述驱动器与所述第一夹爪和第二夹爪的近端接合,因此所述驱动器的纵向移动使所述第一夹爪和第二夹爪在它们的回缩位置与伸出位置之间沿着夹爪引导表面纵向移动。当所述第一夹爪和第二夹爪处于它们的伸出位置时,所述驱动器的纵向移动也相对于所述壳体旋转所述第一夹爪和第二夹爪。
根据更详细的方面,当所述第一夹爪和第二夹爪处于它们的伸出位置时,所述夹爪销接合所述夹爪引导表面的远端。所述第一夹爪和第二夹爪的近端包括具有齿的齿轮,且所述驱动器包括与所述夹爪的齿啮合的对应的齿。所述第一夹爪和第二夹爪的近端形成为小齿轮,且驱动器形成为齿条,由此驱动器和齿条的纵向移动旋转在伸出位置处的小齿轮和第一夹爪和第二夹爪。所述驱动器包括中心脊和齿,所述中心脊纵向延伸,所述齿从所述脊在侧向相对的方向上延伸以形成两组齿,两组齿中的一组与所述第一夹爪的小齿轮接合,所述两组齿中的另一组与所述第二夹爪的小齿轮接合。在一个实施方案中,所述驱动器包括具有第一端和第二端的中心板,且第一组齿从所述中心板的第一端侧向延伸,且第二组齿从所述中心板的第二端侧向延伸,第一组齿和第二组齿在侧向相对的方向上延伸。所述中心板优选在与纵向轴线平行的平面中延伸,并且可包括延伸通过板的远端的槽,所述槽定尺寸为且设置为接收所述夹爪销。在与纵向轴线垂直的平面中,所述中心板和齿组的横截面形成Z形。
在第二方面,提供了一种用于接合组织的医疗装置,所述医疗装置包括壳体、第一夹爪和第二夹爪、驱动器以及驱动线。所述壳体限定了在壳体的近端和远端之间延伸的内部通道和纵向轴线。所述第一夹爪和第二夹爪可相对于所述壳体旋转,并具有近端和远端。所述驱动器与所述第一夹爪和第二夹爪的近端接合,由此所述驱动器的纵向移动相对于所述壳体旋转所述第一夹爪和第二夹爪。所述驱动器包括形成了面向近侧的承口的两个锁定片,并由塑性变形以调节所述承口的尺寸的材料构成。细长驱动线选择性地连接至所述驱动器,以与所述驱动器一起纵向移动。所述驱动线具有紧接着所述驱动线的远端的扩大部分,且所述承口接收所述驱动线的扩大部分。
根据更详细的方面,从所述承口中向近侧抽出所述扩大部分会使所述驱动器塑性变形,并使锁定片向外侧向移动。所述壳体包括引导所述驱动器的纵向移动的引导表面,且所述引导表面包括对应于所述两个锁定片的在所述壳体的相对侧上的两个表面。所述引导表面也优选包括近侧部分、远侧部分和在近侧部分与远侧部分之间的过渡处的肩部。所述肩部面向近侧,由此所述锁定片设置为接合所述肩部,以在所述锁定片被所述驱动线的扩大部分向外侧向移动之后限制所述驱动器的纵向移动。
在第三方面,提供了一种用于接合组织的医疗装置,所述医疗装置包括壳体、第一夹爪和第二夹爪、驱动器、偏置带以及驱动线。所述壳体限定了在壳体的近端和远端之间延伸的内部通道和纵向轴线。所述第一夹爪和第二夹爪可相对于所述壳体旋转,并具有近端和远端。所述驱动器与所述第一夹爪和第二夹爪的近端接合,由此所述驱动器的纵向移动相对于所述壳体旋转所述第一夹爪和第二夹爪。所述偏置带可操作地连接至所述第一夹爪和第二夹爪中的至少一者,以径向偏置所述夹爪。细长驱动线选择性地连接至所述驱动器,以与所述驱动器一起纵向移动。
根据更详细的方面,所述偏置带的第一端接合所述第一夹爪,且所述偏置带的第二端接合所述第二夹爪。所述偏置带的中间部分固定至所述驱动器的远端,并与其一起移动。在另一实施方案中,所述偏置带为第一偏置带,且所述装置也包括第二偏置带。所述第一偏置带具有固定至所述第一夹爪的一端和可滑动附接至所述壳体的另一端。同样地,所述第二偏置带具有固定至所述第二夹爪的一端和可滑动附接至所述壳体的另一端。在本文中,所述壳体的外部包括定尺寸为用以接收第一偏置带和第二偏置带的第一通道和第二通道。所述第一偏置带和第二偏置带分别固定至所述第一夹爪和第二夹爪的远端。
附图说明
引入并形成说明书的一部分的附图图解了本发明的多个方面,并与说明书部分一起用于解释本发明的原理。在附图中:
图1为具有根据本发明的教导构造的用于接合组织的医疗装置的医疗系统的俯视图;
图2为类似于图1的俯视图,但以虚线显示了外部结构,以实线显示了内部截面,并显示了部分横截面;
图3为图1所示的医疗系统和装置的侧视图;
图4为类似于图3的侧视图,但以虚线显示了外部结构,以实线显示了内部结构,并显示了部分横截面;
图5为作为图1-4所示的医疗系统的一部分的医疗装置的侧视图;
图6为形成图1-5所示的医疗系统和装置的一部分的壳体的前视图;
图7为图6所示的壳体的立体图;
图8-12为显示了图1-5所示的医疗系统和装置的操作的侧视图;
图13和图14为示出了图1-4所示的医疗系统和装置的操作的俯视图,其局部地以横截面显示;
图15和图16为显示了图1-4所示的医疗系统和装置的操作的横截面图。
图17和图18为形成图1的医疗系统和装置的一部分的抓握夹爪的一个可选择的实施方案的立体图;
图19为形成图1的医疗系统和装置的一部分的驱动器的一个可选择的实施方案的平面图;
图20为显示为附接至驱动线的图19的驱动器的立体图;
图21为图20的侧视图;
图22a为图1的医疗装置的一个可选择的实施方案的平面图,且图22b为显示为附接至带并形成图22a的医疗装置的一部分的图19的驱动器的平面图;
图23为图1所示的医疗装置的另一可选择的实施方案的平面图;
图24和图25为显示了图23所示的医疗装置的操作的立体图;
图26和图27分别为形成图1所示的医疗系统和装置的一部分的驱动器的另一可选择的实施方案的立体图和端视图;
图28为显示为附接至夹爪的图25-26的驱动器的立体图;
图29和图30为显示了图28所示的驱动器和夹爪的操作的平面图;
图31和图32为图1所示的医疗系统和装置的另一实施方案的横截面图;且
图33为图31和图32所示的医疗系统和装置的立体图。
具体实施方式
本文所用的术语“近侧的”和“远侧的”旨在具有相对于使用者的参照点。特别地,在整个说明书中,术语“远侧的”和“远侧地”应表示通常远离使用者的位置、方向或取向,且术语“近侧的”和“近侧地”应表示通常朝向使用者的位置、方向或取向。
具有用于接合组织T(图11)的医疗装置40的示例性医疗系统20示于图1至图4中。医疗系统20和装置40通常被定尺寸和定结构为用以通过内窥镜(未显示)或其他观测设备的工作通道进行操作,尽管系统20和装置40也可单独使用或与其他细长装置(如导管、光纤可视系统、针等)结合使用。通常,医疗系统20包括驱动线22,所述驱动线22可滑动地容纳于细长导管24的远端23内,以用于选择性地连接至医疗装置40,并用于医疗装置40的操作。如在本文更详细地描述,医疗装置40通常包括壳体42,所述壳体42具有枢转连接于其上的第一夹爪44和第二夹爪46以用于接合组织T。通常,夹爪44、46已显示为形成抓钳,尽管夹爪旨在用于夹住组织,例如以闭合开口或用于止血。因此,可认识到,夹爪的形状和结构可采取许多形式,并用于许多目的和功能,所有这些均根据本发明的教导。
在医疗系统20中,驱动线22可滑动地延伸通过导管24。尽管术语“线”用于指驱动线22,但可认识到可使用能够在一定距离内传输纵向力(如在典型内窥镜、腹腔镜和类似的程序中所要求的那样)的任何细长控制元件,这包括塑料杆或管、单个长丝或复丝线、金属杆等。驱动线22也应能够从近端至远端适当地传输旋转/扭转力,以旋转医疗装置40和夹爪44、46,因此目前优选的是驱动线22由镍钛诺(例如镍钛诺线)或其他超弹性合金形成。连接块26可滑动地安装于导管24的远端23内,并限定了孔28,通过所述孔28可滑动地接收驱动线22。连接块26的外部包括凹陷部分27,两个销钉30(例如由不锈钢线形成)连接至导管24并设置于凹陷部分27内,以限制连接块26的纵向移动。
驱动线22的远端限定远侧头32,所述远侧头尺寸大于驱动线22,同样也大于连接块26中的孔28。如本文在之后描述,远侧头32用于使连接块26在导管24内滑动,以使医疗装置40与医疗系统20分离。还是如图1-4所示,医疗装置40的壳体42为限定有内部空间43的管状元件。壳体42的近端在内部空间43内摩擦接收连接块26的远端,以与其选择性连接。
壳体42的内部通道43也接收第一和第二夹爪44、46以及驱动器48,所述驱动器48用于将驱动线22与夹爪44、46相互连接。如在图1、图2和图5中最佳看出的,驱动器48具有限定承口50的近侧部分,所述承口50定尺寸为接收驱动线22的扩大的远侧头32。两个可偏转锁定片52在承口50的近侧入口处形成,所述可偏转锁定片52相对于驱动器48的剩余部分旋转,以增加或减小承口50的尺寸。锁定片52可分别形成并枢转附接至驱动器48,或者可与驱动器48一体形成,并由弹性材料形成,所述弹性材料折曲以使锁定片52径向向内和径向向外旋转。驱动器48的远侧部分限定用于接合和操作夹爪44、46的齿条54。在所示的实施方案中,齿条54包括具有齿58的中心脊56,所述齿58从中心脊56突出,并在脊56的相对侧上。在脊56的一侧上的一组齿58通常操作第一夹爪44,而在脊56的另一侧上的另一组齿58操作第二夹爪46。应认识到,齿条54可包括一组齿或与夹爪44、46接合的其他啮合结构。
如在图5中最佳看出的,第一和第二夹爪44、46包括定结构为用以抓握和接合组织的远端60、62,所述远端60、62通常具有如2008年12月31日提交的61/141,934中所公开的爪形,所述专利的公开内容以全文引用的方式并入本文。第一和第二夹爪44、46的近端64、66各自包括具有一系列齿的小齿轮68、70。小齿轮68、70的齿与驱动器48的齿条54的齿啮合,使得驱动器48的纵向位移引起第一和第二夹爪44、46相对于彼此旋转。通常,驱动器48向远侧平移使得第一和第二夹爪44、46彼此远离向外旋转,而驱动器48向近侧回缩使得第一和第二夹爪44、46朝着彼此向内旋转。销钉80通过夹爪44、46的近端的每一个安装,以将所述夹爪枢转连接至壳体42。可使用用于形成枢转连接的其他结构,且枢转连接优选相对于小齿轮68、70在中心设置。
除了枢转附接至壳体42的夹爪44、46之外,第一和第二夹爪44、46也可滑动地附接至壳体42。如在图6和图7中(并结合图1-4)最佳所示,壳体42限定了用于第一夹爪44的第一引导表面82和用于第二夹爪46的第二引导表面84。如图3所示,第一和第二引导表面82、84由在壳体42的相对的侧面上形成的细长槽82a、82b、84a、84b形成,这使一定厚度的壳体42暴露以用作引导表面。槽82a、82b对准以接收第一夹爪44的连接销钉80,同样地,槽84a、84b对准以接收第二夹爪46的连接销钉80。所述槽的端部(例如图7所示的远端92、94)用于限制夹爪44、46相对于壳体42的纵向移动。夹爪44、46的近端64、66包括接收销钉80的孔口72、74(图1、图2和图3),所述销钉80用于将第一和第二夹爪44、46可滑动且可枢转地连接至壳体42。
在图6和图7中也可以看出,壳体42限定了第三引导表面86,所述第三引导表面86引导驱动器48在壳体42内的纵向移动。在所示实施方案中的引导表面86包括形成为C形通道的左引导表面86a和右引导表面86b。如图7所示,第三引导表面86从较小的近侧宽度过渡至较大的远侧宽度,以在过渡处限定肩部88,这将参照图13和图14在下文进一步描述。
还如图6所示,壳体42的内部通道43延伸通过所述壳体的远端,第一和第二夹爪44、46可通过所述内部通道43延伸。另外,如图1和图2所示,壳体42限定相对的槽45,所述相对的槽45定尺寸为在第一和第二夹爪44、46径向向外旋转时允许第一和第二夹爪44、46通过。因此,由图1和图2也可能看出,当第一和第二夹爪44、46完全地或部分地包含于壳体42的内部通道43内时,壳体42用于阻止第一和第二夹爪44、46的旋转。用于形成壳体的合适的塑料包括但不限于聚四氟乙烯(PTFE)、膨体聚四氟乙烯(EPTFE)、聚乙烯醚酮(PEEK)、聚氯乙烯(PVC)、聚碳酸酯(PC)、聚酰胺、聚酰亚胺、聚氨酯、聚乙烯(高密度、中密度或低密度),合适的金属包括不锈钢、镍钛诺和类似的医学级别的金属和合金。
现在将参照图8-12描述医疗装置40的操作。如图8所示,第一和第二夹爪44、46显示为在回缩位置,其中第一和第二夹爪44、46基本上包含于壳体42内。取决于应用,夹爪44、46的远端60、62可在它们的回缩位置中从壳体42的远端略微突出,或者它们可完全设置于壳体42内。当驱动线22向远侧位移(向着图8所在页面的右方)时,远侧头32接合驱动器48,且驱动器48和夹爪44、46向远侧滑动通过壳体42。驱动器48和夹爪44、46在旋转之前纵向滑动(尽管驱动器48的齿条54在夹爪44、46的近端64、60处与小齿轮68、70啮合),这是因为纵向移动的阻力小于旋转夹爪44、46所需的力(或者,当夹爪44、46在壳体42内时,壳体42可阻止夹爪44、46的旋转)。如之前所述,该纵向移动由第一和第二引导表面82、84引导,所述第一和第二引导表面82、84接收销钉80,销钉80将夹爪44、46可滑动地且可枢转地连接至壳体42。
如图9所示,第一和第二夹爪44、46具有伸出位置,其中所述夹爪基本上从壳体42的远端突出,且它们的近端64、66与壳体42的远端相邻设置。因此可以看出,驱动线22、因此还有驱动器48的向远侧的前进使得小齿轮68在齿条54的齿58上旋转。如在图10中最佳看出的,第一和第二夹爪44、46远离彼此地径向向外旋转至组织接收位置。特别地,由于在壳体42的远端处的槽45的存在,夹爪44、46允许旋转满90°,由此在夹爪44、46之间形成至少180°。应认识到,通过对槽45定尺寸以及齿条54和小齿轮68、70的构造,第一和第二夹爪44、46可甚至进一步远离彼此地旋转。
在图10所示的组织接收构造中,医疗装置40及其夹爪44、46可与组织T相邻设置。如图11所示,组织T可置于第一和第二夹爪44、46之间,且夹爪44、46朝着它们在图9所示的位置向回旋转。组织T已显示为单层,尽管多层可夹在夹爪44、46之间。通常,驱动线22和驱动器48的向近侧回缩再次使第一和第二夹爪44、46旋转而抓握第一和第二夹爪44、46之间的组织T。如图12所示,驱动线22和驱动器48的进一步的向近侧回缩将使夹爪44、46在近侧方向上纵向移动(朝着图12中页面上的左方)。
为了使医疗装置40用作夹子并保持其抓握在组织T上,或者保持组织的两层彼此挤靠夹紧,夹爪44、46可锁定在适当位置,且医疗系统20的驱动线22与医疗装置40分离。如图13所示,第三引导表面86(其引导驱动器48)包括近侧部分86p和远侧部分86d。第三引导表面86的近侧部分86p具有比第三引导86的远侧部分86d的宽度更大的宽度(在图13所在的页面上上下测得)。如前所述,第三引导表面86由壳体42的相对表面或C形通道86a、86b形成。近侧部分86p与远侧部分86d之间的过渡限定肩部88,即在壳体42的相对侧上的两个肩部88a、88b。肩部88a、88b被定尺寸并设置为接合位于驱动器48上的锁定片52。
如图13所示,当驱动器48位于第三引导表面86的远侧部分86d内时,锁定片52被径向向内推动而与驱动线22牢固摩擦接合。换句话说,由驱动器48形成的接收远侧头32的承口50具有入口,所述入口通过锁定片52的向内偏转而变窄。优选地,锁定片52塑性变形而不是弹性变形,并且在装置的最初组装过程中,片52可围绕远侧头32向内弯折,并因此定尺寸为用于第三引导表面86的远侧部分86d。在图13所示的该状态中,驱动线22与驱动器48牢固接合,因此与第一和第二夹爪44、46牢固接合。
当驱动线22和驱动器48向近侧回缩时,例如如图12所示当抓握组织时,驱动器48的近端被接收在第三引导表面86的近侧部分86p内,所述近侧部分86p具有允许锁定片52的径向向外移动的更大的宽度。因此,在图14所示的状态中,锁定片52可松散且可拆卸地连接至驱动线22的远侧头32。也就是说,夹爪44、46的近侧回缩将受限于接合壳体42的远端的组织T,或者销钉80将邻接限定第一和第二引导表面82、84的槽82a、82b、84a、84b的近端。这样,当夹爪44、46和驱动器48的近侧移动因此受限时,驱动线22及其远侧头32的进一步的近侧移动可用于从驱动器48的承口50抽出远侧头32。该操作也可用于使锁定片52进一步向外径向偏转。在驱动线22上向着远侧的适当量的引导力使得远侧头32通过锁定片52向近侧移动,并使锁定片52径向向外塑性变形。如果组织T的天然弹性趋于将夹爪44、46从壳体中朝着它们的伸出位置拉出,则锁定片52、54将邻接壳体42的第三引导表面的肩部88a、88b,以防止夹爪44、46进一步的远侧移动。
现在来看图15和图16,当驱动线22和远侧头32仍然进一步向近侧回缩时,扩大的远侧头32将邻接连接块26,所述连接块26可滑动地配合于导管24的远端23内。在驱动线22上足够的近侧力将克服连接块26与壳体42的近端之间的摩擦配合,因此向近侧移动连接块26(向着图15和图16所在页面上的右方)以将连接块26回缩至管状连接器24内,如图16所示。导管24可用于在壳体42上提供反作用力,同时向近侧回缩驱动线22和连接块26。因此,驱动线22、导管24和连接块26可与医疗装置40完全分离,由此使第一和第二夹爪44、46和壳体42处于如下状态:将组织T夹在夹爪44、46之间并保持在活体内。连接块26经由销钉30而保持在导管24的远端端部24处,所述销钉30位于凹陷区域27内以接合连接块26的近端端部和远端端部,并限制其纵向移动。
可滑动地围绕驱动线22的细长导管24(或其他细长管状元件,如护套、管、观测设备等)沿着驱动线22向近侧延伸至系统20的近端,并具有适于将装置40置于体内的任意所需的位置的长度,而驱动线22和导管24的近端设置于体外以由医疗专业人员使用。用于控制驱动线22和导管24的相对平移的控制柄(未显示)是本领域公知的,并可在系统20的近端端部处使用。
形成抓握夹爪44、46的另一实施方案和方法示于图17-18中。之前的实施方案的夹爪通常由机加工制成,然而,夹爪44、46也可通过冲压而形成。将优选为医疗级不锈钢的金属的扁平件冲压成图17所示的形状144。所述形状包括略窄的远端160,所述远端160可随后被弯折成图18所示的形状以用于抓握和接合组织。取决于应用,远端160也可冲压为包括锯齿状边缘,或其他形状或边缘特征。近端164通常包括通向齿轮168的两个臂166。如图18所示,抓住齿轮168然后旋转约90度,使得齿轮168在与片材144的平面垂直的平面中延伸。齿轮168也包括用于接收引导销的通孔172。也应认识到,在该实施方案中的夹爪44、46也可由单个臂166和单个齿轮168形成。
驱动器148和驱动线122的另一实施方案示于图19-22中。驱动器148通常包括由两个锁定片152形成的承口150。在该实施方案中,所述锁定片的近侧部分限定倾斜肩部154,所述倾斜肩部154向外侧向倾斜以与如前所述壳体42中的第三引导表面86接合。锁定片152也包括内部突出部153,所述内部突出部153向内侧向突出,并将承口150分离成远侧部分150d和近侧部分150p。驱动器148还包括中心脊156和相对的齿158。在该实施方案中,驱动器148的远端166包括由两个向内突出的凸缘170限定的腔168,如将在本文进一步讨论的那样。两个凸缘170沿着腔168的远侧延伸,并在两个凸缘170之间留下间隙以用于进入腔168。
如图20和图21所示,驱动线122的该实施方案包括远侧头132,所述远侧头132通过将驱动线122的远端弯折成所示的半圆形而形成,所述半圆形优选跨度为180度至360度的弧度。因此,可以看出远侧头132限定开口133,所述开口定尺寸为接收锁定片152的内部突出部153。如所示,承口150的远侧部分150d接收弯曲远侧头132的最远侧部分,而远侧头132的近侧部分突出通过承口150的近侧部分150p,并向近侧远离所述近侧部分150p。如上所述,本文的锁定片152构造为要受到塑性变形,因此在如图19所示形成和连接至驱动线122之后,该片152径向向内弯折,以将突出部153固定至承口132的开口133内。在此状态下,锁定片152的外部肩部154定尺寸为配合于第三引导表面86内,更特别地配合于第三引导表面86的远侧部分86d内而无进一步的变形。
如图22a和图22b所示,医疗装置140的另一实施方案可包括正如之前的实施方案的壳体142、抓握臂144、146,但在该实施方案中包括交替的驱动器148和另外的偏置元件,即偏置带190。如图22b中最佳所示,驱动器148的远端166在腔168内接收偏置带190。凸缘170如所示向内向近侧弯折,以牢固接合金属带190,并将金属带190固定至驱动器148。偏置带190优选为由弹性材料的片材形成的薄带,更优选为例如由不锈钢、镍钛诺或可生物相容的其他超弹性合金形成的金属带。因此,应认识到,当驱动器148向近侧移动而使得夹爪144、146关闭时,偏置带190将被推动成V形或U形,如图22a中的虚线所示。即,偏置带190在其天然非偏置构造下呈直线形状,当偏置带190弯折成V形时,其在夹爪144、146上施加径向向外的力。该偏置力为夹爪144、146提供了在打开位置与关闭位置之间平滑的旋转和过渡。也应认识到,偏置带190也可具有其成型为V形或U形的初始非偏置位置,并附接至夹爪144、146,使得偏置带190施加向内的径向偏置力。金属带190的自由端192只是挤靠夹爪44、46,而不固定至或刚性附接至夹爪44、46。
来看图23,医疗装置240的另一实施方案仍然显示为包括壳体242和可滑动地附接至壳体242的相对的夹爪244、246。壳体242仍然包括用于引导夹爪244、246的移动的第一和第二引导部282、284。然而,在该实施方案中,每个夹爪244、246分别包括偏置带290a、290b。带290a、290b的远端291优选在夹爪244、246的远端被固定附接至夹爪244、246的外部,所述附接优选通过粘合剂、钎焊、焊接或其他已知的结合技术。如图24和图25中最佳所示,壳体240包括在壳体240的相对侧上的两个外部通道294(一个通道显示在图24和图25中),所述两个外部通道294定尺寸为接收弹性带290a、290b,使得弹性带290a、290b在关闭/回缩配置下与壳体的外表面齐平。带290a、290b的近端293包括由基部295和横杆296形成的T形。基部295延伸通过更小的槽296,所述更小的槽296通过壳体240形成。槽296与通道294共同延伸。横杆296沿着壳体240的内部安放,并保持带290与壳体240之间的可滑动连接。因此,可以看出,带290a、290b的近端293经由通道294及其槽296可滑动且可枢转地附接至壳体240,从而允许带290a、290b与抓握夹爪44、46如所示那样在它们的打开位置与关闭位置之间一起行进,如图24和25所示。
现在转向图26-30,显示了驱动器348的另一实施方案。如图26和图27中最佳所示,驱动器348仍然包括由两个锁定片352形成的承口350,所述两个锁定片352具有内部突出部353和外部肩部354,并且将承口350划分为远侧部分353和近侧部分350p。不同于驱动器的之前的实施方案,在该实施方案中远侧部分限定具有Z形的带齿齿条。通常,中心板356代替了之前的实施方案的中心脊56、156,且板356在与壳体342的纵向平面平行的平面中延伸(图29)。中心板356的平面也与驱动器348的近侧半部(即包括承口350和片352)的平面垂直。第一组齿358a在第一方向上远离中心板356侧向突出,而第二组齿358b在第二方向上远离中心板356侧向突出。第一和第二组齿358a、358b从中心板356的相对端延伸,且第一和第二方向通常彼此相对。齿组358a、358b各自由围绕齿358a、358b的周边延伸的两个外框架360牢固保持在中心板356上。
因此,如图28中最佳所示,医疗装置340包括第一和第二抓握夹爪344、346,所述第一和第二抓握夹爪344、346各自具有近端366和啮合齿368,所述啮合齿368被弯折以远离夹爪344的主体而呈直角地突出。因此,第一组齿358a接收第二夹爪346的齿轮368,而第二组齿358b接收第一夹爪344的齿轮368。特别地,所示的侧向/呈直角弯折夹爪344、346的近端366使得单个销钉380经过齿轮368,并因此由两个夹爪344、346共用。而且,如图29所示,壳体342因此可仅包括单个引导表面382,所述单个引导表面382由在壳体342的每个侧向侧面上的单个槽所形成,所述单个槽用于接收单个销钉380的端部。可以看出,第一和第二夹爪344、346由此共用单个引导表面382(夹爪引导表面)和引导槽,因此确保它们的协同操作和平滑的打开和关闭。
还如图29所示,槽357在中心板356中形成,并与销钉380和夹爪引导表面382对齐,以在驱动器348相对于夹爪344、346向前移动时接收销钉380。如上所述并如图30所示,当销钉380(由夹爪344、346的近端366和齿轮368共用)碰撞单个夹爪引导表面382的远端时,驱动器348将继续向远侧移动,以使齿轮368经由驱动器348的齿条/齿358a、358b而旋转,由此引起夹爪344、346的旋转。
来看图31-33,示出了医疗系统420和医疗装置440的另一实施方案。在该实施方案中,医疗系统420仍然包括具有远侧头432的驱动线422,所述远侧头432通过将驱动线422的远端弯折成所示的形状而形成。医疗系统420也包括导管附件430,所述导管附件430通常为连接至导管24的远端并用于可滑动地接收连接块426的管状元件。导管附件430包括一对开口434以提供通向控制线422和连接块426的通路,由此可使用工具来将连接块426保持在回缩或伸出位置,如在与本文同时提交的共同待审的美国申请No.61/391,878以及与本文同时提交的申请No.61/391,875中进一步描述,所述申请的公开内容以全文引用的方式并入本文。
医疗装置440包括壳体442,所述壳体442经由连接块426可拆卸地连接至导管24及其导管附件430。壳体442可滑动地接收经由驱动器448连接至驱动器线422的一对夹爪444。如同之前的实施方案,驱动器448包括由锁定片452限定的承口450,所述锁定片452可释放地接合驱动线422的远侧头432。驱动器448的远侧部分包括多个齿458,所述多个齿458限定了如前所述的用于驱动夹爪444的旋转的齿轮或齿条。驱动器448的远端466包括由凸缘限定的腔,所述凸缘用于固定接合偏置带490。壳体442进一步限定引导夹爪444的纵向和旋转移动的一对引导表面或槽482。
在该实施方案中,夹爪444和壳体442被构造成使得在完全回缩位置(如图所示)下,夹爪44从壳体442的端部向远侧(至少部分)突出。如图32中最佳所示,当远侧头432通过锁定片452被推动时,所述锁定片452向外塑性变形,以接合壳体中的肩部446,且夹爪444被完全回缩。以此方式,壳体442的长度可得以缩短,如同用于在其中引导夹爪444的引导槽482那样。在图32中也可以看出,夹爪444的远端包括锯齿445或可协助抓握组织的其他结构。
也应注意到,在该实施方案中,如同所有之前的实施方案,驱动线422能够通过远侧头432和驱动器448而将旋转力和扭矩(例如来自系统20/420的近侧操作端)传输至夹爪444。这样,医疗装置440可经由驱动线422的旋转而旋转,即夹爪444、夹爪销(例如80)、壳体442和驱动器448均相对于导管24作为一个单元旋转。由于壳体442也可非可旋转地连接至连接块426(例如依靠其间的摩擦),因此当不使用导管附件430时,连接块426也可在导管附件430(或导管,例如24)内旋转。因此,夹爪444的取向可通过驱动线422的近端的旋转而旋转,以相对于被抓握或夹住的组织或材料使夹爪取向。已发现,由固体镍钛诺线形成驱动线422为医疗装置440的旋转提供了良好的扭矩传输。
也已发现,使夹爪444在它们的完全回缩位置处至少部分突出至壳体442外允许夹爪444取向为能够被看见,从而在围绕组织打开和关闭夹爪444之前更易于旋转夹爪444。而且,在组织邻接壳体442的远端之前,另外的组织可被封入夹爪444中。夹爪444从壳体442突出的距离可取决于特定应用而变化,即定尺寸以对应于组织的厚度或形成的工序的类型,以确保夹爪444的远端与壳体442的远端之间的良好间隔。
对本发明的各个实施方案的在前描述是为了说明和描述的目的而提供。其不旨在为穷举的或将本发明限制为所公开的精确实施方案。根据如上教导,许多修改或改变是可能的。选择和描述所讨论的实施方案以提供对本发明的原理及其实际应用的最佳说明,以使本领域普通技术人员能够在各个实施方案中,且使用适合于预期特定用途的各种修改而利用本发明。当根据公平、合法且公正授权的范围进行解释时,所以这些修改和改变都处于由所附权利要求所确定的本发明的范围内。
Claims (20)
1.一种用于接合组织的医疗装置,所述医疗装置包括:
壳体,所述壳体限定了在该壳体的近端与远端之间延伸的内部通道和纵向轴线,并沿着所述内部通道限定了夹爪引导表面,所述夹爪引导表面具有远端;
第一夹爪,所述第一夹爪具有可滑动且可枢转地连接至所述壳体的近端,并且可滑动地接收于所述内部通道内,以在伸出位置与回缩位置之间沿着所述夹爪引导表面纵向移动;
第二夹爪,所述第二夹爪具有可滑动且可枢转地连接至所述壳体的近端,并且可滑动地接收于所述内部通道内,以在伸出位置与回缩位置之间沿着所述夹爪引导表面纵向移动;
单个夹爪销,所述单个夹爪销延伸通过所述第一夹爪和第二夹爪两者的近端,并且接合所述壳体的夹爪引导表面;以及
驱动器,所述驱动器与所述第一夹爪和第二夹爪的近端接合,所述驱动器的纵向移动使得所述第一夹爪和第二夹爪在它们的回缩位置与伸出位置之间沿着所述夹爪引导表面纵向移动,当所述第一夹爪和第二夹爪处于它们的伸出位置时,所述驱动器的纵向移动使所述第一夹爪和第二夹爪相对于壳体旋转。
2.根据权利要求1所述的医疗装置,其中当所述第一夹爪和第二夹爪处于它们的伸出位置时,所述夹爪销接合所述夹爪引导表面的远端。
3.根据权利要求1所述的医疗装置,其中所述第一夹爪和第二夹爪的近端包括具有齿的齿轮,且其中所述驱动器包括与所述夹爪的齿相啮合的对应的齿。
4.根据权利要求3所述的医疗装置,其中所述第一夹爪和第二夹爪的近端形成为小齿轮,且其中所述驱动器形成为齿条,其中所述驱动器和齿条的纵向移动旋转在伸出位置处的小齿轮和第一和第二夹爪。
5.根据权利要求4所述的医疗装置,其中所述驱动器包括中心脊和齿,所述中心脊纵向延伸,所述齿从所述中心脊在侧向相对的方向上延伸以形成两组齿,两组齿中的一组与所述第一夹爪的小齿轮接合,所述两组齿中的另一组与所述第二夹爪的小齿轮接合。
6.根据权利要求4所述的医疗装置,其中所述驱动器包括具有第一端和第二端的中心板,且其中第一组齿从所述中心板的第一端侧向延伸,第二组齿从所述中心板的第二端侧向延伸,所述第一组齿和第二组齿在侧向相对的方向上延伸。
7.根据权利要求6所述的医疗装置,其中所述第一组齿和第二组齿各自包括围绕所述齿延伸的框架。
8.根据权利要求6所述的医疗装置,其中所述中心板在与所述纵向轴线平行的平面中延伸。
9.根据权利要求6所述的医疗装置,其中所述中心板包括延伸通过所述板的远端的槽,所述槽被定尺寸为并设置为接收所述夹爪销。
10.根据权利要求6所述的医疗装置,其中在与所述纵向轴线垂直的平面中,所述中心板和齿组的横截面形成为Z形。
11.一种用于接合组织的医疗装置,所述医疗系统包括:
壳体,所述壳体限定了在所述壳体的近端与远端之间延伸的内部通道和纵向轴线;
第一夹爪,所述第一夹爪可相对于所述壳体旋转,并具有近端和远端;
第二夹爪,所述第二夹爪可相对于所述壳体旋转,并具有近端和远端;
驱动器,所述驱动器与所述第一夹爪和第二夹爪的近端接合,所述驱动器的纵向移动相对于所述壳体旋转所述第一夹爪和第二夹爪,所述驱动器包括形成了面向近侧的承口的两个锁定片,并由塑性变形以调节所述承口的尺寸的材料构成;以及
细长驱动线,所述细长驱动线选择性地连接至所述驱动器,以与所述驱动器一起纵向移动,所述驱动线具有紧接着所述驱动线的远端的扩大部分,且所述承口接收所述驱动线的扩大部分。
12.根据权利要求11所述的医疗装置,其中从所述承口中向近侧抽出所述扩大部分引起所述驱动器塑性变形,并使锁定片向外侧向移动。
13.根据权利要求12所述的医疗装置,其中所述壳体包括引导所述驱动器的纵向移动的引导表面,且所述引导表面包括对应于所述两个锁定片的在所述壳体的相对侧上的两个表面。
14.根据权利要求13所述的医疗装置,其中所述引导表面包括近侧部分和远侧部分以及在所述近侧部分与远侧部分之间的过渡处的肩部,所述肩部面向近侧,且其中所述锁定片设置为接合所述肩部,以在所述锁定片被所述驱动线的扩大部分向外侧向移动之后限制所述驱动器的纵向移动。
15.一种用于接合组织的医疗装置,所述医疗系统包括:
壳体,所述壳体限定了在所述壳体的近端与远端之间延伸的内部通道和纵向轴线;
第一夹爪,所述第一夹爪可相对于所述壳体旋转,并具有近端和远端;
第二夹爪,所述第二夹爪可相对于所述壳体旋转,并具有近端和远端;
驱动器,所述驱动器与所述第一夹爪和第二夹爪的近端接合,所述驱动器的纵向移动相对于所述壳体旋转所述第一夹爪和第二夹爪;
偏置带,所述偏置带可操作地连接至所述第一夹爪和第二夹爪中的至少一者,以径向偏置所述夹爪,所述偏置带直接连接至所述驱动器;以及
细长驱动线,所述细长驱动线选择性地连接至所述驱动器,以与所述驱动器一起纵向移动。
16.根据权利要求15所述的医疗装置,其中所述偏置带的第一端接合所述第一夹爪,且所述偏置带的第二端接合所述第二夹爪。
17.根据权利要求16所述的医疗装置,其中所述偏置带的中间部分固定至所述驱动器的远端,并与其一起移动。
18.根据权利要求15所述的医疗装置,其中所述偏置带为第一偏置带,并且所述医疗装置还包括第二偏置带,所述第一偏置带具有固定至所述第一夹爪的一端和可滑动地附接至所述壳体的另一端,所述第二偏置带具有固定至所述第二夹爪的一端和可滑动地附接至所述壳体的另一端。
19.根据权利要求18所述的医疗装置,其中所述壳体的外部包括定尺寸为用以接收所述第一偏置带和第二偏置带的第一通道和第二通道。
20.根据权利要求18所述的医疗装置,其中所述第一偏置带和第二偏置带分别固定至所述第一夹爪和第二夹爪的远端。
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