CN104023660B - 电极布置和电外科抓握器械 - Google Patents

电极布置和电外科抓握器械 Download PDF

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CN104023660B
CN104023660B CN201280042185.1A CN201280042185A CN104023660B CN 104023660 B CN104023660 B CN 104023660B CN 201280042185 A CN201280042185 A CN 201280042185A CN 104023660 B CN104023660 B CN 104023660B
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A·霍尔勒
H·温特
A·舒尔茨
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Olympus Winter and Ibe GmbH
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Abstract

本发明涉及一种用于电外科抓握器械的电极布置(100)，其具有电极(200a)、加热元件(120a)以及设置在电极(200a)和加热元件(120a)之间并使这两者绝缘的弹性绝缘器(110a)，其中绝缘器(110a)相对于弯曲而言是软的。本发明还涉及一种具有根据本发明的电极布置的电外科抓握器械。

Description

电极布置和电外科抓握器械
技术领域
本发明涉及一种用于电外科抓握器械的电极布置，该电极布置包括电极、加热元件以及设置在电极和加热元件之间并使电极和加热元件彼此绝缘的绝缘器。本发明还涉及一种具有钳夹的电外科抓握器械。
背景技术
电外科抓握器械用于凝结和/或横切组织，例如血管。此外，它们用于熔合两个松散的组织部分，即，将两者永久地密封，由此实现缝合冗余。为此目的，电外科抓握器械通常具有两个钳夹，将待被凝结、横切或熔合的组织固定于两个钳夹之间。通常，电极布置被设置在钳夹上，通过电极布置可以将高频(HF)电压施加至组织。
在特殊应用中，例如在熔合期间，可能有利的是，除电极之外，在器械中还包括加热元件。因而，例如当首先通过HF能量进行熔合，并且随后当升高的组织抵抗力停止通过HF而熔合时，可以通过加热元件的热能而继续熔合。加热电极以便于提供与施加电流无关的能量。为此目的，可以提供加热元件，用于加热电极。由于电流流过电极和加热元件，它们之间需要彼此绝缘。通常，这通过陶瓷绝缘器而实施。然而，陶瓷绝缘器的风险是，在凝结和横切期间发生的高压下，它们会破裂并且因而丧失了它们的绝缘属性。
文献DE 202004 010 311 U1示出了位于分叉处的加热元件。
文献DE 11 2008 000 288 T5示出了用于组织熔合的装置，其也仅进行热操作。
文献US 2008/0015575 A1也示出了通过热而进行组织熔合的装置。
在EP 2 106 762 A1中进一步描述了一种加热元件。
还需要增加电极布置的可靠性。
发明内容
根据第一方面，本发明涉及一种用于电外科抓握器械的电极布置。该布置包括电极、加热元件以及设置在电极和加热元件之间并使电极和加热元件彼此绝缘的绝缘器。绝缘器是有弹性的。
发明人已经发现，电极布置的可靠性可能受以下事实的影响，即，在组织上施加高压期间，抓握器械的用来在其上设置电极布置的钳夹可能会弯曲。由此，高的张应力被施加在绝缘器上。根据本发明第一方面的电极布置有助于使绝缘器在弯曲时不断裂。
根据该应用的绝缘器基本上是电绝缘器，即，具有足够高的电阻以阻止电流的材料。优选地，绝缘器具有良好的导热性。
电极通常由导电材料组成，尤其是由生物相容材料组成。在这一点上，例如各种金属是合适的材料。优选地，电极是平坦的，有利于实现朝向组织的平坦均匀的接触表面。
通常，电极是非柔性的，尤其是，基本上比绝缘器更不具备柔性。因而，电极提供了平坦的接触表面，然而，在应用期间施加的力作用下，可以或多或少进行弯曲。作为选择地，电极也可以是易于延展的，例如弹性的。在该情况下，其可以使自身适应于不平的组织。
电极可以配置为位于绝缘器背离加热元件的那一侧上的层。这可以例如通过涂层方法而实现，其中绝缘器上涂覆电极。在该情况下，电极将是绝缘器的涂层。
然而，相反的设置也同样是有利的。由此，将绝缘器涂覆在电极上。涂层防止了电极和绝缘器之间的气流吹动。在此，电极形成了电极布置的支撑元件。
加热元件通常由具有合适阻抗的材料组成，从而流过其中的电流能使其发热。产生的热量通过绝缘器而传递至电极。电极将热量传递至组织。加热元件可以例如完全或部分地由铁镍合金组成。
加热元件优选具有平坦的结构。其例如可以配置为绝缘器上的层。特别优选的是，加热元件覆盖了绝缘器的表面的主要部分，例如大于绝缘器的表面的80％。绝缘器又优选地覆盖电极的表面的至少90％。从而，达到特别平均的热量产生和分布。
应当指出的是，根据本发明的绝缘器的弹性结构确保了在使用平坦加热元件时绝缘器的可靠性。绝缘器还可以由薄层的陶瓷、玻璃或硅组成，其因而也是柔性的。优选地，材料厚度是几丝米。优选地，加热元件配置为绝缘器的至少2倍厚，尤为优选的是，至少4倍厚。
电极布置优选具有用于温度传感器的一个或多个凹槽。使用这种温度传感器，可以监视电极或已处理的人体组织的温度。这些传感器可以是光学温度传感器。凹槽可以配置成例如为在平坦加热元件中的孔的形式。
然而，作为平坦加热元件的另一替换选择，加热元件还可以配置为以合适方式设置在绝缘器上的加热丝。例如，加热丝可以至少局部折叠地安装或呈螺旋形式。由此，可以实现均匀的热量产生。
优选地，绝缘器完全或局部地由柔性塑料材料组成。聚酰亚胺尤为适于该目的。合适的塑料材料例如通过芳香族二酐和芳香族二胺的缩聚而制成。尤为合适的塑料材料例如是聚(4，4’-氧化二亚苯基-均苯四甲酰亚胺)，其也以杜邦公司的商标名Kapton出售。
优选地，绝缘器具有平坦结构。根据优选实施方式，绝缘器可以是由绝缘、弹性塑料材料制成的箔，加热元件以及通向加热元件的馈线被施加在所述箔上。使用箔有利于以尤其简单的方式生产的实施方式。加热元件可以在将该加热元件施加至箔上之后与箔一同处理。
优选地，加热元件、绝缘器和电极形成层叠结构。这产生了电极布置的尤其简单和坚固的实施方式。
通向加热元件的馈线用于向加热元件提供电流。通常，加热元件需要两条馈线，以便将电流传导通过加热元件。通常，该馈线连接至电连接器，而该电连接器通向外部电流源或电压源。
在该情况下，尤为优选地是，箔和馈线共同形成从被加热元件占据的面横向突出的接触突出片。这有助于尤为简单的生产，因为接触突出片仅需要从一个平面弯曲。在该实施方式中，作为接触突出片的一部分的馈线可以连接至电连接器，而无需直接接触加热元件。
电连接器连接至馈线的点，例如接触突出片上的各点，优选由电绝缘塑料材料覆盖，尤为优选地，由环氧树脂覆盖。为此目的，以商标名“Glob-Top”出售的塑料材料是合适的。由此，已覆盖的部分电绝缘，并且防止受机械损伤。
根据第二方面，本发明涉及一种具有刚性钳夹的电外科抓握器械，其中钳夹具有根据本发明第一方面的一个或多个实施方式的电极布置，其中加热元件面朝钳夹，并且电极面朝组织。电外科抓握器械通常具有至少一个手柄部件和两个钳夹，手柄部件有利于将电外科抓握器械保持在手中。另一方面，钳夹被认为是电外科抓握器械的一部分，其在抓握期间与组织接触并且用于向组织施加压力。
在一个示范性实施方式中，钳夹非柔性地连接至手柄部件，而第二钳夹可旋转地连接至手柄部件。通过相对于手柄部件和第一钳夹旋转附加钳夹，两个钳夹可以共同地执行镊子状的抓握移动。由此，另一钳夹通常通过链接而连接至手柄和第一钳夹，例如通过回转接头、螺纹接头或类似接头等。在该情况下，电外科抓握器械的那些设置在相对于链接来说背离手柄部件的那一侧上的部件通常被称为钳夹。
然而，作为选择地，电外科抓握器械还可以具有两个手柄部件，其中每个手柄部件分别非柔性地连接至一个钳夹，并且其中两个手柄部件及各自相关联的钳夹相对于彼此而围绕链接以可枢转的方式布置。通过将两个手柄部件收缩在一起，在该情况下，可以实现两个钳夹的镊子状的抓握移动。
通过使用根据本发明第一方面的电极布置，实现了用于电外科抓握器械的电极布置的优点。由此，优选的是，在两个钳夹的每一个上提供这种电极布置，其中，两个电极布置朝向彼此。然而，作为选择地，根据本发明第一方面的电极布置还可以仅提供在电外科抓握器械的一个钳夹上。该钳夹通常配置为非柔性的，以有利于在组织上施加必需的压力。为此目的，钳夹通常完全或局部地由不锈钢或另一合适材料组成。
附图说明
将参考随附附图来描述本发明的其他特征、优点和实施方式。
图1示出了根据本发明第二方面的电外科抓握器械；
图2示出了根据本发明第一方面的电极布置的第一实施方式；
图3a示出了根据本发明第一方面的电极布置的第二实施方式；
图3b示出了图3a的实施方式的修改方案；
图4示出了根据本发明第一方面的电极布置的第三实施方式；
图5示出了图4的实施方式处于已安装状态。
具体实施方式
图1示出了根据本发明第二方面的电外科抓握器械10，其具有第一手柄部件20和第二手柄部件25、第一钳夹30和第二钳夹35。第一手柄部件20非柔性地与第一钳夹30连接。同样地，第二手柄部件25非柔性地与第二钳夹35连接。在手柄部件和钳夹之间的各个转接处，第一手柄部件20和第二手柄部件25通过回转接头40而彼此可旋转地连接。
当朝向第二手柄部件25推动第一手柄部件20时，第一钳夹30和第二钳夹35共同形成镊子状的抓握移动。
第一钳夹30配置有面朝第二钳夹35的第一电极布置100。同样地，第二钳夹35配置有面朝第一钳夹30的第二电极布置105。如果第一钳夹30和第二钳夹35共同形成镊子状的抓握移动，那么第一电极布置100和第二电极布置105朝向彼此移动。
电外科抓握器械10还包括连接线180、185、190、195，可以通过这些连接线对电极布置的加热元件和电极供电。下文将对其进行描述。
合适的电极布置100、105分别被描述为图2至图4中的电极布置100。
图2示出了根据本发明第一方面的电极布置100的第一实施方式。电极布置100包括电极200，该电极适于电极-组织接触。电极200可通过连接线190与HF能源连接。配置为由聚(4，4’-氧联二苯基-均苯四酸酰亚胺)制成的箔的绝缘器110被施加在电极200上。
绝缘器需要覆盖电极一侧上表面区域的90％以上。在绝缘器100上，施加有呈加热丝形式的加热元件120。该加热丝局部地配置成蜿蜒形，以便于分别在绝缘器110或电极200的表面上实现尽可能均匀的加热。
包括电极、绝缘器和加热元件的层叠结构以良好的导热方式而互相连接。这可以例如通过合适的胶水或者通过层压、印刷或喷镀而实现。
此外，用于加热元件120的第一馈线130和第二馈线135配置在绝缘器110上。这些部件均与第一接触垫140和第二接触垫145连接。加热元件120可以借助于接触垫140、145而被电接触。
绝缘器110借助于其最大的平坦部分限定了平面。然而，绝缘器110的一小部分以及连接至其的馈线130、135一同弯曲远离该平面，以形成接触突出片115。在此，其配置为U形。由此，接触垫140、145可以通过连接线180、185被接触，而对电极布置100不产生任何机械负荷。此外，在接触垫140、145上，施加了由环氧树脂制成的盖160，其防止接触垫140、145免受机械或化学损伤。
图3a以截面视图示出了根据本发明第一方面的电极布置100的第二实施方式。图3a的视图并未按比例绘制，仅为示意性的。以经参考图2描述了的图3a中所示的绝缘器110、加热元件120和电极200。
图3a中的电极布置示出了另一绝缘器110b，从而加热元件120在两侧被绝缘器110、110b包围。绝缘器110、110b横向突出超过加热元件120。实际上，绝缘器110、110b的厚度仅为几丝米或几忽米，例如0.025mm。加热元件的厚度为0.1至0.2mm，而电极的厚度近似为1mm。
在图3b中示出了图3a的实施方式的修改方案。本文中，加热元件120被包围在绝缘器110、110b之间，绝缘器110、110b共同继续超出加热元件120，如同箔。
加热元件120两侧上的绝缘器110、110b的优点在于加热元件120与钳夹30、35的材料绝缘。
在组织熔合期间，如下使用具有根据本发明的电极布置100、105的抓握元件10。待被熔合的组织层重叠地啮合在两个钳夹30、25之间。电极布置100、105的两个电极200通过连接线190、195而连接至HF发生器(未示出)的双极输出的不同极。加热元件120通过连接线180、185而分别连接至HF发生器的另一双极输出。作为选择地，还可以使用HF发生器的同一双极输出，即，连同可以作为选择地连接加热装置或电极的开关装置。
现在，首先例如通过手动开关或脚踏开关来启动而将HF能量提供至电极200。结果，HF电流通过待被熔合的组织层而在电极布置100、105的电极200之间流动。由HF能量加热组织，并且开始组织熔合。
通过HF电流，组织开始脱水，并且组织阻抗增加。在太少电流流过而进一步加热和熔合组织之前，启动电极布置100、105的加热元件120。
停用HF电极200，即，该电极被从HF发生器的一个输出切换至另一输出。借助于加热元件120，产生热能量并且传递通过电极200，并传送至组织。由于提供了热能，所以维持了组织的熔合。当充分地密封组织层时，停用加热元件，并且完成组织熔合。在组织熔合期间，通过钳夹30、35而在组织层上施加持久的压力，这对于组织熔合具有有利的效果。
作为HF发生器的交流电的备选方案，加热元件120当然还可以通过直流电来加热。然而，交流电更为有利。
图4示出了根据本发明第一方面的电极布置100的第三实施方式。
其包括平坦电极200a，该电极上施加有平坦绝缘器110a。在绝缘器110a上施加有加热元件120，该加热元件与图2的加热元件120相反，配置为平坦的。由此，实现了尤为平均地加热电极200a。
此外，加热元件120a、绝缘器110a和电极200a具有用于温度传感器的三个凹槽170，在图4中示出了三个凹槽中的两个。因而，凹槽170是电极布置中的通道。可以将温度传感器，优选为光学温度传感器，插入这些凹槽170中。为了不影响温度测量，加热元件120a配置为从圆形凹槽170径向地偏离。于是，提供了绝缘偏离。
在图4中未明确地示出馈线和连接线。然而，应当理解，必须如同图2中的加热元件120一样，向图4中的加热元件120a提供电能。为此目的，在接触突出片115a中提供了合适的馈线，如图4中所示。
图5示出了图4的实施方式处于已安装状态。其中，电极布置100被施加在支撑块220上。在该视图中可以清楚地看见电极200a，以及用于温度传感器的三个凹槽170。与图4相比，接触突出片115a进行不同的弯曲；然而，其具有相同的功能。

Claims (15)

1.一种用于电外科抓握器械(10)的电极布置(100、105)，所述电极布置具有电极(200、200a)、加热元件(120、120a)以及设置在所述电极(200、200a)和所述加热元件(120、120a)之间并使所述电极和所述加热元件彼此电绝缘的电绝缘导热绝缘器(110、110a)，其中，所述绝缘器(110、110a)是弹性的。
2.根据权利要求1所述的电极布置(100、105)，其中，所述绝缘器(110、110a)配置为平坦的。
3.根据权利要求1或2所述的电极布置(100、105)，其中，所述绝缘器(110、110a)完全或局部地由柔性塑料材料、玻璃、陶瓷或硅制成。
4.根据权利要求3所述的电极布置(100、105)，其中，所述塑料材料是聚酰亚胺。
5.根据权利要求3所述的电极布置(100、105)，其中，所述塑料材料是聚(4,4'-氧二亚苯基-均苯四酸酰亚胺)。
6.根据权利要求1所述的电极布置(100、105)，其中，所述加热元件(120a)的厚度是所述绝缘器的厚度的至少两倍。
7.根据权利要求1所述的电极布置(100、105)，其中，所述加热元件(120a)覆盖所述绝缘器(110a)的表面的80％以上，并且其中所述绝缘器覆盖所述电极的表面的80％以上。
8.根据权利要求1所述的电极布置(100、105)，其中，加热元件(120a)具有用于温度传感器的一个或多个凹槽(170)。
9.根据权利要求1所述的电极布置(100、105)，其中，所述电极(200、200a)与所述绝缘器(110、110a)相比是非柔性的。
10.根据权利要求1所述的电极布置(100、105)，其中，所述电极(200、200a)配置为平坦的。
11.根据权利要求1所述的电极布置(100、105)，其中，所述绝缘器(110、110a)是由绝缘弹性塑料材料、玻璃、陶瓷或硅制成的箔，所述加热元件(120、120a)以及通向所述加热元件(120、120a)的馈线(130、135)被施加在所述箔上。
12.根据权利要求11所述的电极布置(100、105)，其中，所述箔和所述馈线(130、135)共同形成接触突出片(115)，该接触突出片从被所述加热元件(120、120a)覆盖的表面横向突出。
13.根据权利要求1所述的电极布置(100、105)，其中，所述加热元件(120、120a)、所述绝缘器(110、110a)和所述电极(200、200a)形成层叠。
14.根据权利要求1所述的电极布置(100、105)，其中，所述加热元件(120a)的厚度是所述绝缘器的厚度的四倍。
15.一种包括刚性钳夹(30、35)的电外科抓握器械(10)，其特征在于，所述钳夹(30、35)支撑根据权利要求1至14中任一项所述的电极布置(100、105)，其中，所述加热元件(120、120a)面朝所述钳夹(30、35)。
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