CN104224263B - Eea砧座卡环触发器 - Google Patents
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Abstract
公开了一种手术紧固设备以及与之相联系的使用方法。所述手术紧固设备包括手柄组件、从所述手柄组件延伸的中央主体部、以及具有砧座头组件的远侧头部。所述砧座头组件包括限定了内部凹槽的砧座头、触发板、可变形构件以及紧固构件。砧座中心杆组件限定了纵向轴线并且绕枢转轴线可枢转地连接至砧座头组件。所述砧座中心杆组件包括被配置为当致动手术紧固设备时接触砧座头组件的柱塞。当致动手术紧固设备时,可变形构件被配置为变形以使所述触发板被向远侧推进至内部凹槽中以利于砧座头绕枢转轴线枢转。本发明还公开了一种EEA砧座卡环触发器。
Description
技术领域
本公开总体地涉及用于将手术紧固件施加至身体组织的手术紧固装置。更具体地,本公开涉及适合执行圆形吻合术和/或对中空组织器官的内壁的处理的手术紧固装置。
背景技术
吻合术是将分离的中空器官段进行手术连结。通常,吻合术操作是在去除病变或有缺陷的中空组织段且要连结剩余端部段的手术后进行的。根据所需的吻合术操作,端部段可以通过环形的、端对端的或侧对侧的器官重构方法来连结。
在圆形吻合术操作中,通过紧固件器械连接器官段的两端,所述紧固件器械驱动紧固件(例如,吻合钉)的圆形阵列通过每个器官段的端部段并且同时对被驱动的圆形吻合钉阵列之内的任何组织进行去芯,从而清空管状通道。在序号为6,053,390、5,588,579、5,119,983、5,005,749、4,646,745、4,576,167以及4,473,077的美国专利中公开了用于执行中空器官的圆形吻合术的器械的例子,上述专利的每一个的全部内容均通过引用结合在此。通常,这些器械包括细长轴,所述细长轴在近侧端具有手柄部来致动所述器械并且在其远侧端处布置有紧固件保持部件。砧座组件包括附有砧座头的砧座杆,所述砧座组件被安装在器械的远侧端上,邻近紧固件保持部件。待紧固的中空器官的组织的相对端部在所述砧座头和所述紧固件保持部件之间被夹紧。通过从所述紧固件保持部件中驱动出一个或多个紧固件来连结被夹紧的组织,从而使紧固件的端部穿过组织并且通过所述砧座头变形。同时,环形刀具被推进用来挖出中空器官中的组织,从而清空器官内的管状通道。
在许多用于吻合术操作的手术紧固装置中,砧座组件被配置为使得砧座头在发射手术紧固装置之后相对于砧座杆倾斜或枢转以利于,例如,通过呈现一个较小的横截面轮廓穿过组织来移除或推进所述手术紧固装置。然而,考虑到这种手术紧固装置的可移动部件的紧公差,多种可移动部件可能干涉砧座头相对于砧座杆枢转或倾斜。而且,围绕砧座头和砧座杆的连接点的组织可能干涉砧座头相对于砧座杆枢转或倾斜。
因此,希望提供一种手术紧固设备,其被配置为紧固手术紧固设备的部件以使砧座头可相对于砧座杆自由枢转。更希望提供一种手术紧固设备,其被配置为保持组织与砧座杆和砧座头的连接点隔开从而使得砧座头可相对于砧座杆自由倾斜或枢转。
发明内容
根据本公开的一个方案,公开了手术紧固设备。所述手术紧固设备包括手柄组件、从所述手柄组件延伸出的中央主体部、以及远侧头部。所述远侧头部包括外壳组件和砧座组件。所述砧座组件包括砧座头组件和砧座中心杆组件。砧座头组件包括限定了内部凹槽的砧座头、触发板、可变形构件以及紧固构件。所述内部凹槽支撑触发板,可变形构件被定位在触发板的远侧,并且所述紧固构件被定位在触发板的近侧。所述砧座中心杆组件限定了纵向轴线并且绕枢转轴线可枢转地连接至砧座头组件。砧座中心杆组件包括与砧座头机械连通的柱塞。所述柱塞被配置为在致动手术紧固设备时接触砧座头组件。当致动手术紧固设备时,所述可变形构件被配置为变形以使得触发板被向远侧推进到所述内部凹槽中以利于砧座头绕枢转轴线枢转。
根据本公开的一个方案,砧座头包括从其向近侧延伸的柱。根据本公开的另一个方案,柱可限定被配置为紧固地接纳紧固构件的环形槽。根据本公开的另一个方案,柱可限定贯通其中的孔隙,所述孔隙被配置为与砧座中心杆组件的贯通孔对齐。所述孔隙和所述贯通孔被配置为接纳贯通其中的枢转构件以使砧座中心杆组件可枢转地附接至砧座头组件。
在本公开的一个方案中,可变形构件包括主体和从其延伸出的延伸部。所述延伸部可被配置为相对于主体变形。
根据本公开的另一个方案,枢转轴线横向于纵向轴线。在本公开的另一个方案中,柱塞被配置为在从纵向轴线偏移的位置处接合砧座头组件。在本公开的另一个方案中,砧座头组件包括布置在所述内部凹槽中的切口环。所述切口环可被配置为当致动手术紧固设备时接纳环形刀具。
在本公开的另一个方案中,砧座中心杆组件限定了被配置为抑制砧座头绕枢转轴线枢转的凸脊。在本公开的一个方案中,所述凸脊被配置为接合从触发板延伸出的突缘。在本公开的另一个方案中,当致动手术紧固设备,突缘可被配置为移动离开所述凸脊以利于砧座头绕枢转轴线枢转。
根据本公开的另一个方案,砧座中心杆组件包括可滑动地布置在其上的套管。所述套管可被配置为接合组织。而且,所述套管可被配置为当砧座头绕枢转轴线枢转时向近侧滑动。
根据本公开的另一个方案,公开了使用手术紧固设备的方法,并且包括提供砧座中心杆组件和被可枢转地附接至其上的砧座头组件。所述方法还包括致动手术紧固设备以使环形刀具接触在砧座头组件内的切口环。所述方法进一步包括向远侧推进环形刀具以使切口环移动在切口环的远侧的触发板和可变形构件,可变形构件具有主体和被配置为相对于主体变形的延伸部。所述方法还包括用紧固环来紧固触发板以使砧座头组件相对于砧座中心杆组件枢转。根据本公开的另一个方案,所述方法还可包括使砧座头组件相对于砧座中心杆组件枢转以生成手术紧固设备的较小的横截面轮廓。
附图说明
此处参照附图公开了本公开的手术吻合装置的多种实施例,其中:
图1是根据本公开的手术紧固设备的立体图。
图2是图1所示手术紧固设备的砧座组件的立体图。
图3是图2指示的细节区域的放大图。
图4是图2所示砧座组件的远侧部的立体图。
图5是图2所示砧座组件的侧视图。
图6是沿图2的线段6-6取得的剖视图。
图7是图2所示砧座组件的部件分离视图。
图8是图7指示的细节区域的放大图。
图9是图7指示的细节区域的放大图。
图10是图7所示砧座组件的套管的立体图。
图11是图10所示套管的另一个立体图。
图12是图7所示砧座中心杆的远侧部的立体图。
图13是沿图5的线段13-13取得的剖视图,插入并接合组织。
图14是图13指示的细节区域的放大图。
图15是沿图5的线段15-15取得的剖视图。
图16是沿图5的线段16-16取得的剖视图,插入并接合组织。
图17是图16指示的细节区域的放大图。
图18是沿图5的线段18-18取得的剖视图,发射图1所示手术紧固设备之后。
图19是沿图5的线段19-19取得的剖视图,插入并接合组织,并且砧座头相对于砧座中心杆被倾斜,以及
图20是沿图5的线段20-20取得的剖视图,其中砧座头相对于砧座中心杆被倾斜。
具体实施方式
现参照附图描述本公开的手术紧固设备,其中在遍及几个附图中,相同附图标记代表相同元件。本文所使用的,术语“操作者”可指代本公开的手术紧固设备的任何用户,例如,护士、医生或临床医师。而且,术语“远侧”指示手术紧固设备的较远离操作者的部分或其部件,而术语“近侧”指示手术紧固设备的较接近操作者的部分或其部件。
首先参照图1,本公开的手术紧固设备的实施例被总体地标示为10。简要地说,手术紧固设备10包括近侧手柄组件12、具有弯曲的细长外管14a的细长中央主体部14以及远侧头部16。远侧头部16包括外壳组件27和砧座组件30,这将在下文更详细描述。在一些实施例中,还可以改变主体部14和头部16的长度、形状和/或直径来适合特定手术操作。
手柄组件12包括固定手柄18、发射扳机20、可旋转的接近旋钮22以及指示器24。固定手柄18可由分离的手柄段形成(未显示),分离的手柄段一起为手术紧固设备10的内部部件限定了壳体。可枢转地安装的扳机锁26被紧固至手柄组件12并且被手动地定位以防止手术紧固设备10的无意发射或致动。指示器24被定位在固定手柄18上并且包括用于操作者辨别手术紧固设备10是否已经被发射或被致动和/或手术紧固设备10是否准备好被发射的标志记号,例如色码、文字-数字标签等。
参照图2至图12,砧座组件30包括砧座头组件40和砧座中心杆组件60(最好地显示于图7)。砧座头组件40可枢转地联接到砧座中心杆组件60,这将在下文中更进一步描述。从远侧至近侧,砧座头组件40包括砧座头42、可变形构件46、触发板48、紧固环50、切口环52以及砧座54。
砧座头42限定了弯曲的外表面和由弯曲的外表面限定的内部凹槽42a。沿着内部凹槽42a的外周限定了外部环形突出部42b。柱44在由砧座头42限定的内部凹槽42a内被居中地定位。柱44从由砧座头42限定的内部凹槽42a向近侧突出并且限定了底部44a,底部44a具有一对径向向内地形成于其上的槽口44b,以及围绕其形成的环形槽44c。环形槽44c在柱44的底部44a内在近侧方向上安置在槽口44b之上。柱44还包括联接部44d,其具有贯通其中的孔隙44e以及从其延伸出并用于联接砧座中心杆组件60的齿44f,这将在下文中进一步描述。
可变形构件46包括主体46a,主体46a具有基本上为环形的构造并且限定了贯通其中的中央开口46b。一个或多个延伸部46c从主体46a径向向外地并且向远侧地突出,并且被配置为用于相对于主体46a移动。因此,延伸部46c可由与主体46a不同的材料形成,例如,具有不同(较大或较小)挠性的材料,或可被可枢转地附接至主体46a,例如,经由活动铰链。可变形构件46被配置为放置在砧座头42的内部凹槽42a内,且延伸部46c接触内部凹槽42a的远侧表面并从其上方隔开主体46a。
触发板48被配置为用于布置在砧座头42的内部凹槽42a内,近侧地毗邻可变形构件46的主体46a。触发板48包括基本为环形的底部48a,其限定了沿其外周形成的一个或多个切口48b。凸起的平台48c从触发板48的底部48a向近侧突出,并且限定了中央开口48d,中央开口48d在柱44与环形外部突出部42b之间绕柱44被定位在砧座头42的内部凹槽42a内。一对沿直径相对的突缘48e径向向内地延伸进入中央开口48d。突缘48e接合砧座中心杆组件60的一部分,这将在下文中进一步描述。
紧固环50具有主体50a,其具有基本环形的构造并且可在其外圆周包括一个断口。紧固环50的外圆周的断口可由主体50a的一对锥形端50b限定。紧固环50被配置为在近侧方向放置在触发板48的上方,并且被配置为接合砧座头42的柱44的环形槽44c,这将在下文进一步描述。
切口环52具有基本环形构造并且限定了开口52a,开口52a具有较大直径但是具有与触发板48的凸起的平台48c的外圆周基本类似的构造。如此,切口环52被配置为安装在触发板48的凸起的平台48c上方,从而同心地且径向地将切口环52固定在触发板48上。切口环52限定了被径向地定位在切口环52的外圆周与开口52a之间的环形槽52b。突出物52c从切口环52向远侧突出,并且被配置为与形成于触发板48的底部48a内的切口48b中的一个切口对齐以同心地且径向地绕触发板48固定切口环52从而抑制切口环52与触发板48之间的相对旋转运动。在一个实施例中,切口环52由聚乙烯形成并且使用例如粘合剂被固定地紧固至触发板48。触发板48可由不同的,例如,象金属这种更坚硬的材料形成。可选地,其他构造材料可用来构造触发板48和切口环52。切口环52和触发板48被可滑动地绕柱44安装。
砧座54基本是环形构件,其被配置为支撑在砧座头42的外部环形突出部42b上并且包括多个用于接纳手术紧固件(例如,手术吻合钉(未显示))并使手术紧固件变形的凹穴54a。至少一个突出物54b从砧座54径向向外地延伸并且被定尺寸为接纳在沿着砧座头42的外周形成的切口42c内。突出物54b和切口44c相互接合以使砧座54在砧座头42的外部环形突出部44b内对齐并且抑制砧座52相对于砧座头42旋转以及抑制砧座头42相对于砧座52旋转。
砧座中心杆组件60包括砧座中心杆62、枢转构件63、柱塞64、柱塞弹簧66以及套管68。砧座中心杆62基本是细长、圆柱形构件,其限定了纵向轴线“A”以及贯通其中延伸的管腔62a。砧座中心杆62限定了近侧部62b、中央部62c以及远侧部62d。砧座中心杆62的远侧部62d限定了横向的贯通孔62e,贯通孔62e穿过远侧部62d延伸且其横向于纵向轴线“A”并与纵向轴线“A”侧向间隔。砧座头42的柱44的孔隙44e与贯通孔62e对齐以接纳贯通其中的枢转构件63。枢转构件63是圆柱形构件,其被配置为通过砧座中心杆62的贯通孔62e和柱44的孔隙44e插入并且限定了枢转轴线“B”以使得砧座头42可相对于砧座中心杆62绕枢转轴线“B”枢转。枢转轴线“B”可横向于纵向轴线“A”。因此,枢转构件63可由被配置为抵挡扭转负荷和/或轴向负荷的(例如,金属或合成物)刚性材料形成。
柱塞64基本是细长构件,其可滑动地定位在轴向地贯通中心杆62形成的管腔62a内。柱塞64包括主体64a和从主体向远侧突出的接合指状件64b。接合指状件64b从砧座头42的枢转轴线“B”偏移并且通过柱塞弹簧66被偏置至接合柱44的底部44a。柱塞弹簧66被可压缩地布置在中心杆62的管腔62a内,近侧地毗邻柱塞64以使柱塞弹簧66保持抵靠柱塞弹簧66的一致的远侧偏置。由于柱塞64的接合指状件64b在与从纵向轴线“A”侧向隔开的位置接触柱44,柱44的在柱塞64的接触点与枢转轴线“B”之间的部分作为力矩臂以使砧座头42被正交地(normally)偏置以相对于砧座中心杆62绕枢转轴线“B”枢转或倾斜。
套管68是具有主体68a的基本为圆柱形的构件,主体68a朝向其远侧端限定了孔隙68b。套管68绕砧座中心杆62沿着外表面被可滑动地布置。在预发射或未被致动位置,套管68绕砧座中心杆62的远侧部62d布置以使砧座头42的柱44的齿44f通过套管68的孔隙68b突出。如此,套管68将砧座中心杆组件60和砧座头组件40固定在未被致动位置。套管68被配置为在手术紧固设备10操作期间接合和移动组织,这将在下文进一步描述。
在预发射或未被致动位置,形成于触发板48上的突缘48e接合从砧座中心杆62的远侧部62d向远侧突出的一对对应的凸脊62f。如此,突缘48e与砧座中心杆62的凸脊62f的相互接合抑制砧座头42相对于砧座中心杆62枢转。因此,突缘48e的作用是将砧座头42锁定在未被致动或预发射位置。如上所述的,套管68与砧座头42的柱44的相互接合也具有将砧座头42锁定在预发射或未被致动位置的功能。
需要理解的是,本文描述的手术设备10的多种部件可由任何适合的材料形成以用于预期目的,例如,金属、合成物和/或聚合材料。
现参照图13、图14以及图16,手术紧固设备10可被插入体腔,例如,通过切割口或自然存在的口,以使手术紧固设备10的远侧头部16被定位为接合组织T的邻近段。手术紧固设备10的远侧头部16被定位为使得组织T的邻近段被布置在外壳组件27与砧座头组件40之间,同时砧座中心杆组件60在其间延伸。然后操作者可旋转接近旋钮22(图1)以朝向外壳组件27接近砧座头组件40。然后操作者可接合发射扳机20(图1)以实现手术紧固设备10的一个或多个发射行程。在手术紧固设备10的发射行程过程中,多个紧固件(例如,吻合钉(未显示))从外壳组件27射出并进入砧座54的凹穴54a。在手术紧固设备10的另一个发射行程过程中,环形刀具70(以剖视图显示)通过组织T被向远侧推进并进入切口环52的环形槽52c。切口环52因此被抵靠触发板48向远侧推进,这引起可变形构件46变形。具体地,引起可变形构件46的延伸部46c的变形,即,延伸部46c弯曲、折叠、压扁和/或伸缩以使布置在其上的可变形构件46的主体46b、以及触发板48和紧固环50向更远侧转移进入砧座头42的内部凹槽42a。
当紧固环50向远侧移动,紧固环50的主体50a接合砧座头50的柱44的环形槽44c。紧固环50被配置为“卡住”或以其他方式锁定在环形槽44c中以使紧固环50仍然是绕柱44基本轴向固定的。紧固环50的锥形端可帮助紧固环50转移进入环形槽44c。当紧固环50的主体50a从柱44的环形槽44c径向向外地突出,主体50a沿柱44将触发板48保持在环形槽44c的远侧区域。
而且,当触发板48向远侧移动,触发板48的突缘48e从砧座中心杆62的凸脊62f脱离以使砧座头42在柱塞弹簧64的弹簧偏置下相对于砧座中心杆62自由枢转或倾斜。当砧座头42绕枢转轴线“B”枢转,柱44的齿44f径向向内地回转,并且从所述套管68的孔隙68e脱离。因此,当砧座头42的一侧近侧地枢转或倾斜,砧座头42接合套管68并且近侧地沿砧座中心杆62用凸轮带动套管68。
由于触发板48被远侧地保持在柱44的环形槽44c之方,触发板48的突缘48e仍然与砧座中心杆62的凸脊62f隔开。如此,紧固环50的作用是抑制触发板48不需要的近侧移动以使触发板48的突缘48e重新接合砧座中心杆62的凸脊62f。而且,由于套管68与周围组织“T”接合,套管68的近侧移动可向近侧运载被布置在其上的组织“T”。如此,在砧座头42倾斜期间,组织T被运载远离枢转轴线“B”,以使砧座头42相对于砧座中心杆62的倾斜不被组织“T”抑制。所以,手术紧固设备10被配置为使得砧座头42不被抑制地通过最大枢转角度倾斜以减小手术紧固设备10的横截面,例如,用于从切割口或自然存在的口移出或通过体腔推进。
需要理解的是可以对本公开的实施例做出多种改进。因此,上述描述不应该被理解为是限制性的,而应被理解为仅仅是实施例的示范例。本领域技术人员将可在所附权利要求的范围和精神内预想其他的改进。
Claims (19)
1.一种手术紧固设备,包括:
手柄组件;
中央主体部,其从所述手柄组件延伸出;以及
远侧头部,其包括外壳组件和砧座组件,所述砧座组件包括:
砧座头组件,其包括限定了支撑触发板的内部凹槽的砧座头、被定位在所述触发板的远侧的可变形构件、以及被定位在所述触发板的近侧的紧固构件;以及
砧座中心杆组件,其限定了纵向轴线并且绕枢转轴线可枢转地连接至所述砧座头组件,并且包括与所述砧座头机械连通的柱塞,所述柱塞被配置为在致动手术紧固设备时接触所述砧座头组件;
其中所述砧座头包括从其向近侧延伸的柱,
其中,当致动所述手术紧固设备时,所述可变形构件被配置为变形以使触发板被向远侧推进到所述内部凹槽中到远侧位置以利于砧座头响应所述柱塞的移动绕枢转轴线枢转,同时所述紧固构件向远侧移动以牢固地接合从所述砧座头延伸的柱以将所述触发板保持在所述远侧位置。
2.根据权利要求1所述的手术紧固设备,其中所述柱限定了被配置为紧固地接纳所述紧固构件的环形槽。
3.根据权利要求1所述的手术紧固设备,其中所述柱限定了贯通其中的孔隙,所述孔隙被配置为与所述砧座中心杆组件的贯通孔对齐。
4.根据权利要求3所述的手术紧固设备,其中所述孔隙和所述贯通孔被配置为接纳贯通其中的枢转构件以使砧座中心杆组件可枢转地附接至砧座头组件。
5.根据权利要求1所述的手术紧固设备,其中所述可变形构件包括主体和从其延伸出的延伸部。
6.根据权利要求5所述的手术紧固设备,其中所述延伸部被配置为相对于主体变形。
7.根据权利要求1所述的手术紧固设备,其中所述枢转轴线横向于所述纵向轴线。
8.根据权利要求1所述的手术紧固设备,其中所述柱塞被配置为在从纵向轴线偏移的位置接合所述砧座头组件。
9.根据权利要求1所述的手术紧固设备,其中所述砧座头组件包括布置在所述内部凹槽内的切口环。
10.根据权利要求9所述的手术紧固设备,其中所述切口环被配置为当致动所述手术紧固设备时接纳环形刀具。
11.根据权利要求1所述的手术紧固设备,其中所述砧座中心杆组件限定被配置为抑制砧座头绕所述枢转轴线枢转的凸脊。
12.根据权利要求11所述的手术紧固设备,其中所述凸脊被配置为接合从触发板延伸出的突缘。
13.根据权利要求12所述的手术紧固设备,其中,当致动手术紧固设备时,所述突缘被配置为移离所述凸脊以利于所述砧座头绕所述枢转轴线枢转。
14.根据权利要求1所述的手术紧固设备,其中所述砧座中心杆组件包括可滑动地布置在其上的套管。
15.根据权利要求14所述的手术紧固设备,其中所述套管被配置为接合组织。
16.根据权利要求15所述的手术紧固设备,其中所述套管被配置为在砧座头绕枢转轴线枢转时向近侧滑动。
17.根据权利要求10所述的手术紧固设备,其中所述切口环被配置为:经由向远侧推进所述环形刀具,而移动在切口环远侧的触发板和可变形构件。
18.根据权利要求17所述的手术紧固设备,其中所述紧固构件为紧固环,所述砧座头组件被配置为:通过所述砧座头组件的柱与所述紧固环接合来紧固触发板,以相对于砧座中心杆组件枢转。
19.根据权利要求17所述的手术紧固设备,其中所述砧座头组件被配置为:相对于砧座中心杆组件枢转以生成手术紧固设备的较小的横截面轮廓。
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Also Published As
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EP2813187A1 (en) | 2014-12-17 |
AU2014203103B2 (en) | 2018-06-14 |
US20140367450A1 (en) | 2014-12-18 |
US10499921B2 (en) | 2019-12-10 |
CA2853850A1 (en) | 2014-12-12 |
CN104224263A (zh) | 2014-12-24 |
EP2813187B1 (en) | 2017-08-02 |
JP2015000344A (ja) | 2015-01-05 |
ES2639178T3 (es) | 2017-10-25 |
AU2014203103A1 (en) | 2015-01-22 |
US9532780B2 (en) | 2017-01-03 |
US20170065279A1 (en) | 2017-03-09 |
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