CN104284633A - 输精管切除装置及方法 - Google Patents
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Abstract
本发明公开了用于烧灼管状脉管的装置和方法。用于烧灼管状脉管的装置可包括:手持件;末端部分,该末端部分设置在手持件的操作端处;一个或多个探针,该一个或多个探针从末端部分延伸;一个或多个抓持臂,该一个或多个抓持臂延伸超过末端部分,并且该一个或多个抓持臂可移动以抓持定位在末端部分处的或靠近末端部分的目标组织;以及功率源,该功率源构造成向该一个或多个探针供应能量。
Description
相关申请
本申请要求于2012年4月5日提交的美国专利申请第13/440,618序列号的权益,该美国专利申请所公开的全部内容通过引用结合于此。
技术领域
本文公开的主题总体上涉及一种用于使雄性(男性,male)患者绝育的装置和方法。更具体地,本文所公开的主题涉及输精管切除装置和方法,以用于供应RF能量来切除雄性患者的输精管。
背景技术
雄性绝育通常通过输精管切除术实现,在输精管切除术中,通过结扎和/或通过烧灼而手术地中断将精子携带到睾丸之外的导管(即,输精管),从而阻止精子从睾丸流向前列腺。这个过程需要手术地打开阴囊。理想地,输精管切除术是期望在仅对患者造成轻度不适的前提下完成的门诊手术。然后,患者应当能够在合理的时间范围内恢复其正常活动。大部分情况具有这种程度的成功结果和有限的副作用。
然而,在相当数量的情况下,在手术中和手术后伴随过度不适的延长探查和操纵可使得结果不够理想。可能出现并发症,这至少部分地因为阴囊组织是高度弹性的。尽管少量的出血通过在非弹性组织中产生的张力而被快速地止住,但弹性组织提供很少的压力来减慢血液和流体的损失。因此,即使最小量的持续出血也可导致巨大的血肿。因此并且除了导致不适之外,愈合过程也变慢,原因在于重新吸收这些流体和细胞所需的时间延长,从而增加了细菌定植的机会。
此外,对于外科医生而言另一关心的问题是输精管的不易确定性。这个结构直到该过程的后期阶段才能被看到,并且该结构必须通过触诊来识别。一旦该结构被识别并且被运送到手术区域中,其必须借助于某些固定装置而保持就位。即使输精管的瞬间释放也会允许其立即返回到精索内,必须使其再次从精索脱出。此外,将局部麻醉剂注射到阴囊皮肤及输精管周围的区域中使得对该结构的触诊变得困难。输精管的固定装置的损耗可导致需要增加解剖,并且操纵可导致增加的出血和肿胀。
即使最有经验的输精管切除术外科医生有时也会遇到这些问题。因此,期望一种用于执行输精管切除术的系统和方法,以减轻这些并发症。特别地,期望这样一种系统和方法,即,其允许医疗专业人员安全地且可控地将输精管保持就位并且在不切割患者的阴囊的壁的情况下使雄性患者绝育。
发明内容
根据本公开,提供了用于烧灼管状脉管的装置和方法。如一个实例并且在一个方面中,提供了一种用于烧灼管状脉管的装置。该装置可包括:手持件;末端部分,该末端部分设置在手持件的操作端处;一个或多个探针,该一个或多个探针从末端部分延伸;一个或多个抓持臂,该一个或多个抓持臂延伸超过末端部分,并且该一个或多个抓持臂可移动以抓持定位在末端部分处的或靠近末端部分的目标组织;以及功率源,该功率源构造成向所述一个或多个探针供应能量。
在另一个方面中,一种用于烧灼管状脉管的装置可包括:手持件;末端部分,该末端部分能选择性地连接至手持件的操作端;一个或多个探针,该一个或多个探针从末端部分延伸;一个或多个抓持臂,该一个或多个抓持臂连接至末端部分并延伸超过该末端部分;以及射频能量发生器,该射频能量发生器构造成向所述一个或多个探针提供射频能量。另外,所述一个或多个抓持臂能移动以抓持定位在末端部分处的或靠近末端部分的目标组织。
在又一个方面中且在一个实例中,提供了一种用于烧灼管状脉管的方法。该方法可包括:提供一装置,该装置包括手持件、设置在手持件的操作端处的末端部分、从末端部分延伸的一个或多个探针以及延伸超过末端部分的一个或多个抓持臂。该方法还可包括:将装置定位成靠近或抵靠容纳管状脉管的身体;使用所述一个或多个抓持臂抓持管状脉管;移动所述一个或多个探针以接触管状脉管;以及向所述一个或多个探针提供能量以烧灼管状脉管。
尽管已在上文中阐述了本文所公开的主题的一些方面,并且这些方面全部地或部分地通过本公开主题而实现,但其他方面随着当结合如在下文最佳描述的附图时所进行的描述而变得显而易见。
附图说明
将通过下面的详细说明而更容易地理解本主题的特征和优点,该详细说明应该结合仅通过解释性和非限制性实例的方式给出的附图而阅读,并且在附图中:
图1A和图1B是根据本公开主题的输精管切除器械的实施例的侧视图;
图2是根据本公开主题的实施例的输精管切除器械的侧视图,其中,末端部分从手持件拆除;
图3是根据本公开主题的实施例的输精管切除器械的一次性末端的侧视图;
图4是根据本公开主题的实施例的输精管切除器械的俯视图;以及
图5、图6、图7A和图7B是根据本公开主题的实施例的输精管切除过程中的步骤的示图。
具体实施方式
本文公开的主题提供了一种供应能量以用于对医学患者的管状脉管进行烧灼的装置和方法。具体地,例如,该器械和方法可用于切除、凝结和/或以其他方式阻塞或封闭雄性患者的输精管。在(仅例如但不限于)图1A到图4中所示的一个方面,本文公开的主题提供了一种医学上使用的装置或器械,其总体上被标示为装置10,该装置或器械可用于执行输精管切除过程。装置10可包括总体上标示为20的手持件以及总体上标示为30的末端部分,所述末端部分可定位在手持件20的操作端处。一个或多个探针32可从末端部分30延伸并为医学切除(ablation,消融,烧蚀)过程(例如,输精管切除过程)提供能量。
如图1A-图4所示,探针32可构成双极电极。具体地,例如,探针32可为射频切除(RFA)的探针,其构造成向目标组织提供RF能量以用于切除目的。在一个特定的构造中,探针32的尺寸(例如但不限于)可为近似22标准尺寸(gauge,标准规格)并且其长度为近似2cm。探针32中的每一个均可包括沿着探针32的长度(除了在远离末端部分30的端部处外)的绝缘护套33。护套33可防止电流在除暴露端部处之外的探针32之间流动。因此,可降低远离探针32的操作端的组织意外损伤的可能性。
探针32能相对于末端部分30移动,这样使得探针32可相对于末端部分的表面而选择性地延伸,以可替换地使探针32隐藏或暴露。如图1和图2中所示,例如,探针32能移动地缩回到末端部分30中。为了实现这个移动,装置10可包括位于手持件20上的探针位置控制器(该探针位置控制器总体上被标示为22),该探针位置控制器的移动使探针32相应地移动。特别地,例如在图1A和1B中所示的,探针位置控制器22可为滑动按钮,该滑动按钮定位在手持件20的一侧上,并且该滑动按钮可朝向末端部分30移动以延伸探针32,或者该滑动按钮可移动远离末端部分30以缩回探针32。这样,探针32能移动到“存放”位置,以保护探针32免于损坏、防止探针32被污染和/或防止探针32在预期使用之前无意地刺穿、刮擦或以其它方式损伤组织。
装置10可进一步包括一个或多个抓持臂34,该一个或多个抓持臂可从手持件20延伸超过末端部分30,并且该一个或多个抓持臂能移动以抓持目标组织并因此将该组织保持就位以用于将探针32作用于该目标组织上。具体地,抓持臂34可构造成抓持包含在身体内的管状脉管。在输精管切除过程情况下,例如,抓持臂34可构造成抓持雄性患者的包含在阴囊内的输精管,从而允许探针32来切除输精管。
与探针32的位置的控制类似,抓持臂34的位置同样可由控制元件调节。即,装置10可包括位于手持件20上的抓持器位置控制器(其总体上被标示为24),该抓持器位置控制器的移动使抓持臂34对应地移动。特别地,如例如在图1中所示的,抓持器位置控制器24可为第二滑动按钮,该第二滑动按钮定位在手持件20的一侧上,并且该第二滑动按钮能朝向末端部分30移动以使抓持臂34朝向彼此移动(即,抓持输精管)或者使抓持臂远离彼此移动(即,释放输精管)。这样,抓持臂34能选择性地移动,以将目标组织保持就位并使其稳定,以用于探针32切除该组织。
装置10可连接至功率源40,该功率源可向探针32供应能量。在一个特定的实例中,功率源40可为射频发生器。参照图1A,装置10可通过导线或缆线42连接至功率源40。本领域内的普通技术人员将认识到的是,功率源40可包括电平调节器,以调节供应至探针32的功率输入。可替换地,如在图1B中所示的,功率源40可包括电源44(例如,电池组)和RF发生器46,该电源和RF发生器集成到手持件20中,以允许装置10易于运输和操作而无需束缚于单独的功率源。在任一种构造中,为了致动探针32,装置10可包括致动器26,该致动器可以是触发器机构,其与如在图1和图2中所示的火器的触发器机构类似。因此,通过拉动致动器26,可调节从功率源40向探针32的能量供应。
在一些构造中,末端部分30可为一次性部分,其可选择性地从手持件20拆除。如在图2中所示的,例如,手持件20可包括从其端部延伸的安装柱28。末端部分30可包括互补的凹槽,该互补的凹槽构造成接收安装柱28并使末端部分30与手持件20的端部对准(即,使得用于探针32的移动的机构对准)。在这个结构中,装置10可用于在医学患者上执行一过程,并且一旦完成该过程,则可从手持件20拆除末端部分30并将其丢弃。这样,可以减少有关患者之间的污染问题,这是因为位于给定末端部分30上的探针32可用于仅单个患者。换句话说,因为仅有探针32的端部构造成用于非表面地接触患者,所以手持件20能够以带新的末端部分30的方式重复使用于后续患者。另外,因为探针32可设计成用于单次使用的手术,所以可基本上消除有关探针32的劣化问题或机械磨损的问题。
无论输精管切除装置10的具体构造如何,输精管切除装置10均可用于执行输精管切除术的方法,如图5-7B中所示的。首先,如在图5中所示的,患者的输精管V可被医生抓持并被升高到恰好位于阴囊S的表面下方的位置。例如,在医生站在患者的一侧同时患者躺在检查台上的情况下可实现这种布置。在用抗菌液体清洗阴囊之后,可注射局部麻醉剂(例如1%利多卡因)以经由针头产生局部皮肤麻醉。如在图5中所示的,例如,当医生用他或她的左手抓持输精管V时可执行该过程的这个部分。
如在图6中所示的,在实现局部麻醉之后,医生通过使末端部分30邻近阴囊S而定位器械10(直接抵靠阴囊S或者仅邻近于阴囊),其中,输精管V位于皮肤的正下方。从这个位置,医生可使抓持器位置控制器24致动(例如,朝向阴囊S滑动抓持器位置控制器24),以使得抓持臂34包围输精管V(诸如通过将输精管V限制在抓持臂34之间)。可替换地,如在图7A和7B中所示的,抓持臂34可构造成到达输精管V的后方,以防止输精管V后退回到阴囊S。这样,抓持臂34可不仅用于对准输精管V并使其稳定,而且可当通过探针32延伸抵靠输精管V和/或延伸进入该输精管中而施加压力时将输精管V保持就位。
在当以这个方式使输精管V稳定的情况下,医生可使探针位置控制器22致动(例如,朝向阴囊S滑动探针位置控制器22)以延伸探针32。装置10可特别地设计成使得抓持臂34将输精管V约束在与探针32对齐的位置中。这样,探针32可延伸到阴囊S中(即,穿过阴囊皮肤)并延伸至紧邻且接触输精管V的位置或者延伸至刺穿输精管V的位置,如在图7A和7B中所示的。
在由探针32刺穿输精管V之后,医生可向探针32提供能量,以切除、凝结或以其它方式阻塞或封闭输精管V。例如,在装置10具有图1A-图4中所示的构造的情况下,医生可操作致动器26以启动向探针32的能量(例如,RF能量)的供应。当能量从探针32中的一个移动到另一个时,发生输精管V的烧灼。
在已经发生充分的破坏和烧灼之后,致动器26可被释放,导致向探针32流动的能量停止。在该过程中的这个时间点,医生可诸如通过移动探针位置控制器22(例如,使探针位置控制器22滑动远离阴囊S)而缩回探针32,从而允许探针32从阴囊S内收回。抓持器位置控制器24可移动(例如,滑动远离阴囊S),以从其抓持位置释放输精管V。探针32进入阴囊S中的进入点可用抗生素药膏覆盖,以促进愈合。
可相信的是,与典型的过程相比,相对于这个过程而言的愈合过程可被显著地缩短,这是因为使用本文所描述的装置的方法仅产生进入阴囊中的两个刺入伤口(在局部麻醉剂经由注射而给药之后),并且输精管V的烧灼和破坏可在短时间内完成。因此,本方法可在不需要手术切除一部分输精管V的情况下执行,而仍实现雄性绝育的相同期望效果。
在不背离本发明的精神和实质特征的前提下,本主题可以其它方式实施。因此,所描述的实施例被认为在所有方面均是说明性的而不是限制性的。例如,虽然本主题的讨论呈现为涉及在执行雄性绝育时使用,但其也可类似地应用在其它相关的应用中,诸如其它管状脉管或输卵管的烧灼。在这点上,尽管已经针对某些优选实施例描述了本主题,但对于本领域内普通技术人员显而易见的其它实施例也在本主题的范围内。
Claims (21)
1.一种用于烧灼管状脉管的装置,所述装置包括:
手持件;
末端部分,所述末端部分设置在所述手持件的操作端处;
一个或多个探针,所述一个或多个探针从所述末端部分延伸;
一个或多个抓持臂,所述一个或多个抓持臂延伸超过所述末端部分,所述一个或多个抓持臂能移动以抓持定位在所述末端部分处的或靠近所述末端部分的目标组织;以及
功率源,所述功率源构造成将能量供应至所述一个或多个探针。
2.根据权利要求1所述的装置,其中,所述末端部分能选择性地从所述手持件移除。
3.根据权利要求2所述的装置,其中,所述末端部分是设计成用于单次使用的一次性部分。
4.根据权利要求1所述的装置,其中,所述一个或多个探针包括双极电极的两个探针。
5.根据权利要求1所述的装置,其中,所述一个或多个探针能相对于所述末端部分的表面移动,使得所述一个或多个探针能相对于所述末端部分的所述表面而选择性地延伸。
6.根据权利要求5所述的装置,所述装置还包括探针位置控制器,所述探针位置控制器能相对于所述手持件移动,其中,所述探针位置控制器的移动相应地导致所述一个或多个探针相对于所述末端部分的移动。
7.根据权利要求6所述的装置,其中,所述探针位置控制器包括第一滑动按钮,所述第一滑动按钮定位在所述手持件的一侧上。
8.根据权利要求1所述的装置,其中,所述一个或多个抓持臂连接至所述末端部分。
9.根据权利要求1所述的装置,所述装置还包括抓持器位置控制器,所述抓持器位置控制器能相对于所述手持件移动,其中,所述抓持器位置控制器的移动相应地导致所述一个或多个抓持臂的移动。
10.根据权利要求9所述的装置,其中,所述抓持器位置控制器包括第二滑动按钮,所述第二滑动按钮定位在所述手持件的一侧上。
11.根据权利要求1所述的装置,其中,所述目标组织包括雄性的输精管。
12.根据权利要求1所述的装置,其中,所述功率源包括射频能量发生器,所述射频能量发生器构造成用于向所述一个或多个探针供应射频能量。
13.根据权利要求12所述的装置,其中,所述功率源被结合到所述手持件中。
14.根据权利要求1所述的装置,所述装置还包括致动器,所述致动器构造成调节从所述功率源供应至所述一个或多个探针的供应能量。
15.一种用于烧灼管状脉管的装置,所述装置包括:
手持件;
末端部分,所述末端部分能选择性地连接至所述手持件的操作端;
一个或多个探针,所述一个或多个探针从所述末端部分延伸;
一个或多个抓持臂,所述一个或多个抓持臂连接至所述末端部分并延伸超过所述末端部分,所述一个或多个抓持臂能移动以抓持定位在所述末端部分处的或靠近所述末端部分的目标组织;以及
射频能量发生器,所述射频能量发生器构造成向所述一个或多个探针提供射频能量。
16.一种用于烧灼管状脉管的方法,所述方法包括:
提供一装置,所述装置包括手持件、设置在所述手持件的操作端处的末端部分、从所述末端部分延伸的一个或多个探针以及延伸超过所述末端部分的一个或多个抓持臂;
将所述装置定位成靠近或抵靠包含管状脉管的身体;
使用所述一个或多个抓持臂抓持所述管状脉管;
移动所述一个或多个探针以接触所述管状脉管;以及
向所述一个或多个探针提供能量以烧灼所述管状脉管。
17.根据权利要求16所述的方法,其中,所述管状脉管包括雄性的输精管。
18.根据权利要求16所述的方法,其中,所述末端部分能选择性地从所述手持件移除,其中,提供一装置的步骤包括将所述末端部分附接至所述手持件。
19.根据权利要求16所述的方法,其中,移动所述一个或多个探针以接触所述管状脉管的步骤包括刺穿所述身体。
20.根据权利要求16所述的方法,其中,向所述一个或多个探针提供能量的步骤包括向所述一个或多个探针提供射频能量。
21.根据权利要求16所述的方法,其中,向所述一个或多个探针提供能量的步骤包括将所述一个或多个探针连接至功率源。
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WO2013151570A1 (en) | 2013-10-10 |
IN2014DN08419A (zh) | 2015-05-08 |
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