CN105682567B - 手术紧固件施加装置 - Google Patents
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- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0813—Accessories designed for easy sterilising, i.e. re-usable
Abstract
本公开涉及用于将紧固件顺序地施加至身体组织的手术紧固件施加装置(10)。所述装置包括：夹紧半部(12)，其具有远侧砧座附接部(12b)和近侧手柄部(12a)；钉仓接收半部(14)，其具有手柄部(22)和细长通道部(24)，所述细长通道部构造成可释放地接收单次使用装载单元，并且所述手柄部构造为可释放地接收发射组件(20)；砧座构件(16)，其构造为可释放地支撑在夹紧半部的远侧砧座附接部内；以及发射组件，其构造为可释放地支撑在钉仓接收半部的手柄部内。
Description
技术领域
本公开涉及一种手术紧固件施加装置，并且，更具体地，涉及一种具有可重复使用的和一次性的部件的手术紧固件施加装置。
背景技术
如下的手术紧固件施加装置在本领域中是公知的：其中组织首先被抓握和夹紧在相对的钳夹结构之间，然后借助手术紧固件结合。在一些这样的装置中，提供刀具以切割已经通过紧固件结合的组织。尽管紧固件通常是手术吻合钉的形式，但是也可使用其它手术紧固件，诸如，例如，夹子或两部分聚合手术紧固件。
手术紧固件施加装置通常包括两个细长梁构件，所述两个细长梁构件用于捕获或夹紧其间的组织。通常情况下，梁构件中的一个承载容纳布置为至少两个横排的多个吻合钉的一次性钉仓组件，而另一梁构件包括限定如下表面的砧座：所述表面用于当吻合钉被从钉仓组件驱动时使吻合钉腿成形。在使用两部分紧固件的情况下，包括砧座的梁构件承载两部分紧固件的配合部件，例如接收器。
一般地，吻合钉成形过程受到一个或多个纵向移动的凸轮构件和一系列独立的吻合钉推动器之间的相互作用的影响。由于凸轮构件纵向行进通过钉仓承载梁构件，独立的推动器构件向上偏置入支撑在钉仓组件内的吻合钉的后跨部以从钉仓顺序地射出吻合钉。刀具可以设置为与凸轮构件一起在吻合钉排之间行进，以切割成形的吻合钉排之间的组织。这种器械的例子公开在美国专利第7,631,794号中，上述专利的全部通过引用合并于此。
由于与消毒不当有关的危险，使用后手术紧固件施加装置通常是处理掉的。尽管在单个患者上执行多个紧固件施加操作的手术操作期间可以替换钉仓组件，但是在手术操作已经完成后吻合钉施加装置通常是处理掉的，并不用在不同的患者上。处理性的这一要求可能增加与手术操作有关的成本。虽然已开发可重复使用的紧固件施加装置，但是这样的装置可能过于复杂且证明为很难消毒。
在本领域存在对如下紧固件施加装置的需求：其包括可重复使用的部件，不过于复杂，并且构造为利于在手术操作中使用后的恰当消毒。
发明内容
本公开涉及一种用于将紧固件顺序地施加至身体组织的手术紧固件施加装置。所述装置包括：夹紧半部，其具有远侧砧座附接部和近侧手柄部；钉仓接收半部，其具有手柄部和细长通道部，所述细长通道部构造成可释放地接收单次使用装载单元，并且手柄部构造为可释放地接收发射组件；砧座构件，其构造成可释放地支撑在夹紧半部的远侧砧座附接部内；以及发射组件，其构造成可释放地支撑在钉仓接收半部的手柄部内。
在一个实施例中，发射组件可以包括静止壳体、发射操作杆以及紧固至所述发射操作杆的凸轮杆。所述砧座构件可以独立于夹紧半部是可一次性的，并且所述夹紧半部是可重复使用的。所述静止壳体可以包括具有底壁和一对侧壁的U形框架。每个侧壁可以具有限定了止动件的近侧端，所述止动件构造为延伸通过钉仓接收半部的近侧端内的开口，以将静止壳体可释放地保持在手柄部内。发射组件还可以包括构造成接合支撑在单次使用装载单元内的刀具的刀具致动杆。发射组件还可以包括轴向地固定在U形框架内的导块和与U形框架可滑动地定位的滑块。发射操作杆可以可枢转地紧固至所述滑块，并且凸轮杆可以固定地紧固至滑块。滑块能够通过U形框架滑动以推进凸轮杆通过细长通道构件的远侧部。
在一些实施例中，钉仓接收半部包括在其近侧端上的限定竖直狭槽的支撑构件，并且，夹紧半部包括在其近侧端上的构造成可释放地接合所述支撑构件的突起。砧座附接部可以包括构造成可释放地接合砧座构件的近侧部的一对圆柱形柱。所述砧座构件可以包括一对狭槽。所述一对狭槽可以构造成接收所述一对圆柱形柱。所述一对狭槽可具有面对不同的方向的开口端。砧座附接部可以包括两对半弧形狭槽，每对半弧形狭槽构造为可选择地接收形成在钉仓接收半部上的一对横向支撑构件。所述夹紧半部和钉仓接收半部中的每个的手柄部可以穿孔。所述夹紧半部和钉仓接收半部中的每个的手柄部可以包括抓握部。所述夹紧半部和钉仓接收半部中的每个的手柄部可以包括拇指接合抵接件。所述手术紧固件施加装置可以还包括构造为可释放地接收在钉仓接收半部的细长通道部内的单次使用装载单元。
附图说明
现在将参照附图在本文描述本处公开的手术紧固件施加装置的各种实施例，其中：
图1是本处公开的手术紧固件施加装置处于夹紧位置的实施例的立体图；
图2是图1所示的手术紧固件施加装置的部件分离的立体图；
图3是图1所示的手术紧固件施加装置的夹紧半部的立体图；
图4是图1所示的手术紧固件施加装置的钉仓接收半部的立体图；
图5是图1所示的手术紧固件施加装置的砧座构件的立体图；
图6是图1所示的手术紧固件施加装置的SULU和发射组件的立体图；
图7是从图6所示的发射组件上方的前端立体图；
图8是图7所示的细节指示区域的放大图；
图9是从图7所示的发射组件上方的后端立体图；
图10是图9所示的细节指示区域的放大图；
图11是图9所示的发射组件的部件分离的侧视立体图；
图11A是图11所示的发射组件的凸轮杆的仰视立体图；
图11B是图11所示的发射组件的发射操作杆的仰视立体图；
图12是图1所示的手术紧固件施加装置的SULU的侧视立体图；
图13是图12所示的细节指示区域的放大图；
图14是图12所示的SULU的前视立体图；
图15是图14所示的细节指示区域的放大图；和
图16是图14所示的SULU的部件分离的侧视立体图。
具体实施方式
现在将参照附图详细说明依照本公开的在本处公开的手术紧固件施加装置的实施例，在附图中，在几幅视图的每个中，相同附图标记指代相似或相同的结构元件。如本文所用，传统的，术语“近侧”指的是装置的较靠近用户的端部，而术语远侧指的是装置的较远离用户的端部。
图1至图16示出了本处公开的总体指定为手术吻合器10的手术紧固件施加装置的一个实施例。具体参照图1和图2，手术吻合器10包括夹紧半部12、钉仓接收半部14、砧座构件16、单次使用装载单元18(以下称“SULU”)和发射组件20。在一个实施例中，夹紧半部12、钉仓接收半部14和砧座构件16构造为是可重复使用的部件，并因此，由适于消毒和重复使用的生物相容性材料(例如，不锈钢)构成。相比之下，SULU 18和发射组件20构造成是一次性的，并且因此，可以由具有所需的强度特性的任何合适的生物相容性材料构成，例如，塑料、金属、其组合。在一些实施例中，砧座构件16构造为一次性的。
参照图1至图3，夹紧半部12包括近侧手柄部12a和远侧砧座附接部12b上。手柄部12a形成为符合人体工程学，且包括抓握部180和拇指接合抵接件182。手柄部12a穿孔，便于清洗和/或减少手术吻合器10的重量。手柄部12a的近侧端包括向下延伸的突起186。突起186可具有基本上圆形的横截面，但是可以设想其它构造。远侧砧座附接部12b限定构造成接收砧座构件16的近侧端的凹槽13。一对圆柱形柱218a、218b延伸越过凹槽13。每一个柱218a、218b定位为接合砧座构件16的附接部196。附接部196形成在砧座构件16的近侧端，并将在下面进一步详细地讨论。砧座附接部12b进一步构造为接合钉仓接收半部14的中间部，以实现手术吻合器10向夹紧位置的移动(图1)。具体地，如将在下面更详细地讨论的，砧座附接部12b包括构造为分别接收形成在钉仓接收半部14上的横向支撑构件194a和194b的第一对半弧形狭槽172a和第二对半弧形狭槽172b。
同样参照图5，砧座构件16包括位于近侧的附接部196和定位在附接部196的远侧的吻合钉变形部198。附接部196构造为接收在夹紧半部12的砧座附接部12b的凹槽13内并限定第一狭槽197a和第二狭槽197b，第一狭槽197a构造成接收砧座附接部12b的圆柱形柱218a，第二狭槽197b与第一狭槽197a相反且与其纵向隔开并构造为可操作地接收砧座附接部12b的圆柱形柱218b。砧座构件16至夹紧半部12的组装可以通过将砧座构件16的附接部196插入砧座附接部12b的凹槽13内从而使得砧座附接部12b的第一圆柱形柱218a接收在附接部196的第一狭槽197a内而实现。一旦第一圆柱形柱218a接收在第一狭槽197a内，砧座构件16沿远侧方向向下枢转以将第二圆柱形柱218b定位在第二狭槽197b内。当手术吻合器10处于夹紧位置(图1)时，柱218a、218b在附接部196的狭槽197a、197b内的定位将砧座构件16相对于夹紧半部12并关于钉仓接收半部14紧固，以控制砧座构件16和SULU 18之间的组织间隙。
仍参照图5，如本领域中公知的，砧座构件16的吻合钉变形部198包括多个吻合钉变形凹槽并且当SULU 18附接到钉仓接收半部14时面对SULU 18的顶表面。如在本领域中同样是已知的，吻合钉变形部198包括用于当刀具40移动通过SULU 18时接收SULU 18的刀具40(图16)的中央纵向狭槽(未示出)。吻合钉变形部198可以形成为与砧座附接部196一体，或者替代的，通过紧固工艺(例如焊接)而紧固至砧座附接部196。一对定位指状件170定位成邻近砧座构件16的吻合钉变形部198的近侧端。当手术吻合器10处于夹紧位置时，定位指状件170接收在SULU 18的沟槽中以正确对准SULU 18与砧座构件16的吻合钉变形部198。此外，定位指状件170起到限定砧座构件16和SULU 18之间的组织间隙的作用。
参照图1、图2和图4，钉仓接收半部14包括手柄部22和一体形成的从手柄部22向远侧延伸的细长通道部24。手柄部22形成为符合人体工程学，且包括抓握部190和拇指接合抵接件192。手柄部22穿孔，便于清洁和/或以减少手术吻合器10的重量。如将在下面进一步详细讨论的，手柄部22限定了定尺寸为可释放地接收发射组件20的大致U形通道22a(图2)，并且细长通道部24限定了定尺寸为可释放地接收SULU 18的大致U形通道24a。
仍参照图1、图2和图4所示，钉仓接收半部14还包括横向支撑构件174a、174b，横向支撑构件174a、174b位于细长通道部24的近侧并且定位成分别接收在夹紧半部12的半弧形狭槽172a、172b内。在组装夹紧半部12和钉仓接收半部14期间，形成在夹紧半部12的砧座附接部12b中的半弧形狭槽172a、172b分别接收钉仓接收半部14的横向支撑构件174a、174b。钉仓接收半部14的近侧端包括竖直支撑构件188。支撑构件188包括狭槽188a，狭槽188a构造成在组装期间当夹紧半部12支撑在钉仓接收半部14上时选择性地接收形成在夹紧半部12的近侧端上的突起186。竖直狭槽188a构造成使得在吻合器10的组装期间夹紧半部12的突起186卡扣配合在竖直狭槽188a内以紧固夹紧半部12与钉仓接收半部14。在一个实施例中，竖直狭槽188a可以构造为以卡扣配合式接合来接收突起186。
现在参照图6至图11B，发射组件20包括静止壳体26，静止壳体26具有包括止动件29的近侧端。止动件29延伸到形成在钉仓接收半部14的手柄部22的近侧部中的凹槽(未示出)以将发射组件20的近侧端可释放地紧固在手柄部22的大致U形通道22a内，将在下面更详细讨论。发射组件20的远侧端限定三角形切口64d，三角形切口64d定位成接收形成在钉仓接收半部14的内壁上的突起(未示出)以将发射组件20的远侧端可释放地紧固在手柄部22内。发射组件20的结构也将在下面进一步详细讨论。同样，SULU 18包括一对远侧突起32，远侧突起32定位在形成在通道部24的远侧端处的切口34(图4)内，以将SULU 18可释放地紧固在通道部22内。在组装期间，发射组件20必须在SULU 18插入通道部24的U形通道24a之前插入手柄部22的U形通道22a，这将在下面讨论。为将SULU 18定位在通道部24内，SULU 18上的突起32定位在切口34内，同时SULU 18定位在通道部24上方并与其成角度。此后，SULU 18可向下旋转到U形通道24a中。这允许发射组件20的驱动部件与SULU 18的部件正确地对准并且还利于发射组件20与支撑在SULU 18内的刀具40(图16)接合。SULU 18的近侧端包括向外延伸的锯齿表面42(图6)以利于SULU 18的近侧端的抓握，以允许SULU 18从通道部24的去除和/或更换。如下面将要讨论的，在吻合器10向夹紧位置的移动之前，锯齿抓握表面42不会完全安置在通道部24内。
参照图7至图11B，发射组件20还包括刀具致动杆44、凸轮杆46、导块48、发射操作杆50、滑块52和踏板(pedal)54。在一个实施例中，静止壳体26包括U形框架60，U形框架60包括底壁62和一对侧壁64。每个侧壁64的远侧端限定了近侧台阶64b、远侧倾斜部64c(图8)和三角形切口64d。如以上所讨论的，三角形切口64d定位成接收形成在手柄部22的内壁上的突起。
仍参照图7至图11B，导块48包括限定三个纵向狭槽70a-c的主体和一对向外延伸的突起72(图11)。在一个实施例中，每个突起72是大致圆柱形的并包括锥形部72a(图8)。替选地，可以设想其它突起构造。突起72定尺寸为接收在形成于静止壳体26的侧壁64中的开口74(图11)中以将导块48轴向地固定在静止壳体26的远侧端内。突起72允许导块48在U形框架60内的一定程度的枢转运动。如将在下面进一步详细地讨论的，响应于吻合器10向夹紧位置的移动，导块48从与刀具致动杆44的槽口49和51锁定接合的第一位置向与刀具致动杆44的槽口49和51脱离的第二位置枢转。扭转弹簧(未示出)关于突起72设置以促进导块48与槽口49和51锁定接合。狭槽70a和70c中的每个都定尺寸为可滑动地接收凸轮杆46的相应的侧壁114。类似地，狭槽70b定尺寸为可滑动地接收刀具致动杆44。
滑块52包括毂80，毂80包括构造成卡扣配合到形成于发射操作杆50的枢轴孔82的弹性指状件80a。当滑块52处于缩回位置时发射操作杆50能关于毂80枢转以利于发射组件20从吻合器10的任一侧的致动。踏板54(图11)往复地接收在形成在滑块52中的孔84内。踏板54包括构造为横跨刀具致动杆44的近侧端102的分裂主体部54a。在一个实施例中，分裂主体部54a包括倾斜的远侧表面86。销88从踏板54通过滑块52中的孔84向上延伸。偏置构件90围绕销88定位在分裂主体部54a和滑块52之间，以促使踏板54远离滑块52向下到延伸位置。在滑块52的缩回位置时，踏板54接收在形成于钉仓接收半部14的手柄部22的底壁中的切口(未示出)中。
发射操作杆50包括第一手指接合构件50a和第二手指接合构件50b，其中任一个可选择性地被接合以从吻合器10的任一侧将发射操作杆50移动通过发射行程。弧形凹槽94(图11B)形成在发射操作杆50的底表面中，弧形凹槽94可滑动地接收踏板54的销88以限定如下旋转范围：发射操作杆50可关于滑块52的毂80枢转上述旋转范围。如本文所使用的，发射行程定义为发射操作杆50从完全缩回位置到完全推进位置的移动。止挡槽94a形成在弧形凹槽94的每一端中。止挡槽94a构造成且定尺寸为：在手术吻合器10的发射行程期间，接收踏板54的销88的端部，以防止发射操作杆50关于毂80的枢转运动。更具体地，在发射操作杆50移动通过发射行程期间，当发射组件20致动以在静止壳体26内向远侧推进滑块52，踏板54的倾斜的远侧表面86接合钉仓接收半部14的手柄部22并且凸轮运动地离开静止壳体的狭槽121(图11A)和通道22a的切口(未示出)以促使销88向上进入止挡槽94a从而防止发射操作杆50的枢转运动。如可以明显看出的，销88必须定位在止动槽94a的下方，以允许踏板54从切口和狭槽121向上提起，从而允许发射操作杆50移动通过发射行程。因此，发射操作杆50必须在发射操作杆50可以移动通过发射行程之前枢转到发射组件20的一侧或另一侧。
如图11所示，刀具致动杆44包括具有台阶部100的近侧端，台阶部100包括具有第一高度的近侧第一台阶102和具有比第一高度大的第二高度的第二台阶104。致动杆44的远侧端包括上翘钩部106和上下槽口49和51。指状件108从刀具致动杆44在第一台阶102和第二台阶104之间向上突出。指状件108可滑动地接收在形成于滑块52的下侧的凹槽(未示出)内。当滑块52在静止壳体26内向远侧推进时，指状件108在凹槽内移动，使得滑块52相对于刀具致动杆44移动直到指状件108接合限定凹槽的近侧端的壁(未示出)。当指状件108接合所述壁时，滑块52的进一步的远侧移动也会影响刀具致动杆44的远侧移动。如将从下面显而易见的，这种布置允许吻合钉在通过刀具40(图16)切割组织之前从SULU 18射出。
参照图11和图11A，凸轮杆46包括一对侧壁114和底壁116(图11A)。每个侧壁114的近侧端114a包括凸起的壁部118。每个凸起的壁部118构造成固定地接收在形成于滑块52的下侧的狭槽(未示出)中，以将凸轮杆46的近侧端固定地紧固至滑块52。替选地，滑块52可关于刀具致动杆44的近侧端模制。每个侧壁114的远侧端包括倾斜的凸轮表面114b。底壁116限定向远侧延伸的细长狭槽123(图11A)和向近侧延伸的纵向狭槽121，其中，细长狭槽123从凸轮杆46的远侧端沿凸轮杆46的绝大部分长度延伸。狭槽121定位成：当滑块52处于缩回位置时，利于踏板54通过形成在手柄部22的通道22a的近侧端中的切口(未示出)。
凸轮杆46的侧壁114可滑动地定位在导块48的狭槽70a和70c中，并且刀具致动杆44可滑动地定位在导块48的纵向狭槽70b中。当发射组件20支撑在钉仓接收半部14的手柄部22中，且发射操作杆50枢转到静止壳体26的一侧并被向远侧推动，滑块52在静止壳体26内向远侧移动。当滑块52开始向远侧移动，踏板54的锥形表面86接合限定了切口的手柄部22的近侧边缘以向上推动踏板54通过凸轮杆46的狭槽121离开切口，并且到达发射组件20的静止壳体26的内表面上。当这发生时，踏板54的销88移入止挡槽94a，以防止发射操作杆50的进一步的枢转运动。如果发射操作杆50不枢转到销88定位在止挡槽94a的下方的位置，踏板54将被防止向上移动离开狭槽121，并且将防止发射操作杆50移动通过发射行程。当发射操作杆50向远侧移动时，指状件108在凹槽内移动，使得当凸轮杆46向远侧推进时，刀具致动杆44保持静止。当指状件108接合限定形成在滑块52的下侧的凹槽的近侧壁时，刀具致动杆44与滑块52和凸轮杆46向远侧移动。如下面将要讨论的，当凸轮杆46和刀具致动杆44在发射组件20的静止壳体26和手柄部22内向远侧移动时，凸轮杆46的倾斜的凸轮表面114b移动通过SULU 18以从SULU 18射出紧固件。同时，尽管有等于形成在滑块52的下侧的凹槽的长度的预设延迟，刀具致动杆44驱动刀片40通过SULU 18以剖切组织。
美国专利第7,631,794号(下称“‘794专利”)公开了一种包括与上述的类似的发射组件的手术紧固件施加装置。‘794专利整体通过引用并入本文。
图12至图16说明SULU 18。参照图16，SULU 18包括主体120、多个吻合钉推动器122(仅示出一个)、底盖124、具有倾斜的锋利前边缘或刀片40a的刀具40、多个吻合钉126(仅示出一个)以及可枢转地安装的安全锁定件128。主体120的近侧端包括突出成略微超过限定主体120的外壁的柔性指状件120a。当SULU 18可释放地定位在通道部24内时，指状件120a摩擦接合通道部24的内壁以将SULU 18的近侧端保留在通道部24内。如本领域中已知的，主体120具有多排(例如，四排、六排等)吻合钉保持狭槽130以及居中布置在主体120中的线性开槽的刀轨132。手术吻合器10可以定尺寸为接收或容纳具有不同吻合钉线长度的SULU，所述吻合线长度包括例如60毫米、80毫米与100毫米。刀具40包括下翘钩部40b，下翘钩部40b定位成当SULU 18定位在通道部24内时接合刀具致动杆44的上翘钩部106(图11)。
在图示的实施例中，主体120包括形成在线性开槽的刀轨132的任一侧上的两个交错排的狭槽130。交错排的狭槽130延伸超过刀轨132的远侧端，以利于在刀片40的行程的远侧端外的吻合钉成形。
仍参照图12至图16，吻合钉推动器122可以构造成延伸到一个或多个狭槽130。在一个实施例中，单个推动器与每个狭槽130相关联。替选地，如图16所示，每个推动器122可构造成延伸入两个相邻的狭缝130并且定位在保持在狭槽130中的相应的吻合钉126下方。如本领域中已知的，每个推动器122包括下凸轮表面122a，下凸轮表面122a定位成接合在凸轮杆46的远侧端的凸轮表面114b(图11)中的一个使得凸轮杆46的通过SULU 18的移动依次地提起在相应的狭槽130内的相应的推动器122以从狭槽130射出吻合钉。
底盖124部分地包围形成在钉仓主体120内的通道(未示出)。纵向脊134形成在底盖124的上表面上并提供用于刀具支撑构件136的支承表面，其中，刀具支撑构件136紧固至刀具40的底边缘。刀具40可以通过销、焊接或其它已知紧固技术紧固至支撑构件136。在发射行程期间，当发射操作杆50通过手柄部22推进时，刀具40被沿刀轨132(图12)引导。一对狭槽138限定在脊134的两侧和钉仓主体120的外壁之间。纵向脊134定位在主体120内并且定尺寸为可滑动地接收在凸轮杆46的细长狭槽120(图12A)中，使得凸轮杆46关于纵向脊134可滑动地移动通过钉仓主体120以从SULU 18射出吻合钉126。
安全锁定件128可枢转地布置在主体120的上近侧端并且能关于枢转构件150从锁定方位枢转到解锁方位。枢转构件150接收在主体120的开口154中。偏置构件，例如弹簧152，定位在刀具支撑构件136和安全锁定件128之间，以朝向解锁方位推动安全锁定件128。安全锁定件128包括近侧钩156，近侧钩156定位成当刀具40处于缩回位置时接收形成在刀具40上的接合构件158以将安全锁定件128保持在锁定方位。发射行程期间当刀具40朝向推进位置移动时，响应于弹簧152的推动，接合构件158远离近侧钩156移动，以允许安全锁定件128朝向解锁位置枢转。注意的是，当夹紧半部12与钉仓接收半部14处于夹紧位置时，因为安全锁定件128的顶表面128a接合夹紧半部12的内表面以防止安全锁定件128的枢转，所以防止了安全锁定件128枢转到解锁位置。安全锁定件128限定定尺寸为可滑动地接收刀具40的狭槽160。在刀具40的缩回位置中，刀具40的前缘40a被限制在安全锁定件128的狭槽160内，以防止与刀具40的前缘40a的意外接合和对医务人员的伤害。
为了将发射组件20装载入钉仓接收半部14的手柄部22，发射组件20的静止壳体26通过手柄部22的近侧端滑入手柄部22的U形通道，直到枢转构件29接收在形成于手柄部22的近侧端中的凹槽30中。在装载发射组件20之后，SULU 18可以通过上述讨论的方式装载到通道部24的U形通道24a中。
参照图1至图3，在SULU 18和发射组件20装载到钉仓接收半部14之后，夹紧半部12可以组装到钉仓接收半部14。为将夹紧半部12附接至钉仓接收半部14，夹紧半部12定位成使得钉仓接收半部14的横向支撑构件174a接收在砧座附接部12b的第一对半弧形狭槽172a内，并且横向支撑构件194b与半弧形狭槽172b对准。此后，夹紧半部12朝向钉仓接收半部14旋转以将横向支撑构件172b定位在半弧形狭槽194b内。夹紧半部12旋转，直到形成于夹紧半部12的近侧端上的突起186接收在形成于钉仓接收半部14的近侧端上的支撑件188中的竖直狭槽188a内。在图1中所示的夹紧位置中，砧座构件16的吻合钉变形部198定位成与SULU 18的顶表面紧密靠近。
参照图7和图11，如以上所讨论的，导块48可枢转地支撑在发射组件20的静止壳体26中。导块48包括向远侧延伸的鼻部220(图11)，当SULU 18支撑在通道部24中时，鼻部220位于SULU 18的下方。导块48的内表面包括锁定表面(未示出)，当吻合器10处于非夹紧位置时，所述锁定表面接收在刀具致动杆44的槽口49和51中。当SULU 18定位在通道部24中时，SULU 18定位在鼻部220上面并且未完全安置在通道部24中，如以上所讨论的。当吻合器10移动到夹紧位置时，砧座构件160的定位指状件170(图2)接合SULU 18的主体120的顶表面以使SULU 18完全安置在通道部24中。如上所述，定位指状件170接收在SULU 18的沟槽中，以相对于砧座构件16正确地定位SULU 18。当SULU 18完全安置于通道部24中时，SULU 18向下压导块48的鼻部220以使导块48关于突起72枢转。当导块48枢转时，所述锁定表面从槽口49和51移动以解锁刀具致动杆44。此构造防止在夹紧之前刀具致动杆44就相对于导块48移动，从而确保使用前的刀具致动杆44和SULU刀具40保持正确地定位用于操作性接合。
当吻合器10处于夹紧、未发射位置时，发射组件20的滑块52处于在手柄部22和静止壳体26的近侧端处的缩回位置。在这个位置中，踏板54定位在通道22a的切口和静止外壳26的狭槽121中，并且踏板54的销88定位在发射操作杆50的在止挡槽94a的下方的弧形凹槽94中。因此，发射操作杆50可以枢转以利于从吻合器10的任一侧致动手术吻合器10。另外，在滑块52的这个位置中，刀具致动杆44的指状件108定位为邻近形成在滑块52的下侧中的凹槽的远侧壁。
当滑块52处于缩回位置时，刀具40和凸轮杆46的凸轮表面114b定位在SULU 18的近侧端，并且安全锁定件128的近侧钩156定位为与刀具40的接合构件158接合以将安全锁定件128保持在锁定方位。另外，刀具40的下翘钩部40b与刀具致动杆44的上翘钩部106接合以将发射组件20连接到SULU 18的刀具40。
当发射操作杆50向远侧推进时，滑块52在发射组件20的静止壳体26内向远侧移动，以实现凸轮杆46的对应的移动和刀具致动杆44的延迟移动。如上所述，刀具致动杆44的延迟移动等于形成在滑块52的下侧的凹槽的长度，并且由于刀具致动杆44的指状件108在滑块52的凹槽内的移动而产生。当指状件108抵接形成在滑块52的下侧中的凹槽的近侧壁时，刀具致动杆44与滑块52的移动开始。当凸轮杆46向远侧移动通过发射组件20的静止壳体26时，凸轮杆46的侧壁114上的凸轮表面114b通过SULU 18推进以顺序地接合推动器122从而从主体120的狭槽130射出吻合钉126。同时，由于刀具致动杆44的远侧端与刀具40接合，在预设延迟之后，刀具40通过SULU 18推进以切割吻合钉线之间的组织。
当滑块52在静止壳体26内向远侧移动时，踏板54在手柄部22上方向上去，并沿发射组件20的静止壳体26的内表面移动。当发生这种情况，踏板54的销88移入止挡槽94a，以防止发射操作杆50的进一步枢转运动。
当刀具40在SULU 18内向远侧移动时，刀具40的接合构件158与安全锁定件128的近侧钩156脱离。
发射操作杆50返回到其最近侧位置以缩回凸轮杆46和刀具40。手术吻合器10通过使形成在夹紧半部12的近侧端上的突起186从形成在钉仓接收半部14的近侧端上的支撑构件188中的竖直狭槽188a内脱离而移动到打开位置。在打开位置中，夹紧半部12从钉仓接收半部14间隔开，并且弹簧152(图16)使安全锁定件128关于枢转构件150枢转到其解锁位置，使得安全锁定件128从SULU 18向上凸起。在解锁位置中，安全锁定件128防止吻合器10返回到夹紧位置的移动。为了重复使用手术吻合器10，用过的SULU 18必须用新的SULU 18来替换。
在手术操作期间，SULU 18可多次更换，以利于吻合器10在单个患者上的多次使用。由于每个SULU 18设置有新的刀具40，组织的撕裂最小化。在手术操作后，可以将使用过的SULU 18和发射组件20从钉仓接收半部14移除，并以适当的方式处置。夹紧半部12、钉仓接收半部14和砧座构件16现在可以消毒(例如通过高压消毒)，并用上面所讨论的方式与消毒的SULU 18和发射组件20一起重新使用。因为发射组件20是一次性的，更少面积留在可重复使用的部件上用于组织和流体捕获。这样，装置的可重复使用的部件可以更容易地消毒。如上所述，在替代实施例中，砧座构件16也可以在手术操作之后处理掉。
应当理解的是，可以对本文所公开的手术紧固件施加装置的实施例进行各种修改。因此，上面的描述不应当解释为限制性的，而仅仅是作为实施例的范例。那些本领域的技术人员将在本公开的范围和精神内设想其它修改。
Claims (13)
1.一种手术紧固件施加装置，包括：
夹紧半部，其包括远侧砧座附接部和近侧手柄部；
钉仓接收半部，其包括手柄部和细长通道部，所述细长通道部构造成可释放地接收单次使用装载单元，并且所述手柄部构造为可释放地接收发射组件；
砧座构件，其构造成可释放地支撑在夹紧半部的远侧砧座附接部内；以及
发射组件，其构造成可释放地支撑在钉仓接收半部的手柄部内，
其中所述砧座附接部包括构造成可释放地接合砧座构件的近侧部的第一圆柱形柱和第二圆柱形柱，
其中所述砧座构件包括第一狭槽和第二狭槽，
其中所述第一狭槽构造成接收所述第一圆柱形柱，并且所述第二狭槽构造成接收所述第二圆柱形柱，
其中所述第一狭槽和所述第二狭槽具有面对相反的方向并且沿纵向彼此隔开的开口端，并且
其中砧座构件构造成当所述第一圆柱形柱接收在所述第一狭槽内时沿远侧方向向下枢转以将所述第二圆柱形柱定位在所述第二狭槽内。
2.根据权利要求1所述的手术紧固件施加装置，其中，所述发射组件包括静止壳体、发射操作杆以及紧固至所述发射操作杆的凸轮杆。
3.根据权利要求1所述的手术紧固件施加装置，其中所述砧座构件独立于夹紧半部是可一次性的，并且所述夹紧半部是可重复使用的。
4.根据权利要求2所述的手术紧固件施加装置，其中所述静止壳体包括具有底壁和一对侧壁的U形框架。
5.根据权利要求4所述的手术紧固件施加装置，其中，所述侧壁中的每一个具有限定了止动件的近侧端，所述止动件构造为延伸通过钉仓接收半部的近侧端内的开口，以将静止壳体可释放地保持在手柄部内。
6.根据权利要求2所述的手术紧固件施加装置，其中所述发射组件还包括构造成接合支撑在单次使用装载单元内的刀具的刀具致动杆。
7.根据权利要求4所述的手术紧固件施加装置，其中所述发射组件还包括轴向地固定在所述U形框架内的导块和与所述U形框架可滑动地定位的滑块，其中，所述发射操作杆可枢转地紧固至所述滑块，并且所述凸轮杆固定地紧固至所述滑块，所述滑块能够通过所述U形框架滑动以推进凸轮杆通过细长通道构件的远侧部。
8.根据权利要求1所述的手术紧固件施加装置，其中所述钉仓接收半部包括在其近侧端上的限定竖直狭槽的支撑构件，并且，所述夹紧半部包括在其近侧端上的构造成可释放地接合所述支撑构件的突起。
9.根据权利要求1所述的手术紧固件施加装置，其中所述砧座附接部包括两对半弧形狭槽，每对半弧形狭槽构造为可选择地接收形成在钉仓接收半部上的一对横向支撑构件。
10.根据权利要求1所述的手术紧固件施加装置，其中，所述夹紧半部和钉仓接收半部中的每个的手柄部被穿孔。
11.根据权利要求1所述的手术紧固件施加装置，其中，所述夹紧半部和钉仓接收半部中的每个的手柄部包括抓握部。
12.根据权利要求1所述的手术紧固件施加装置，其中，所述夹紧半部和钉仓接收半部中的每个的手柄部包括拇指接合抵接件。
13.根据权利要求1所述的手术紧固件施加装置，还包括构造为可释放地接收在钉仓接收半部的细长通道部内的单次使用装载单元。
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Also Published As
| Publication number | Publication date |
|---|---|
| JP2016534791A (ja) | 2016-11-10 |
| CA2926748A1 (en) | 2015-05-07 |
| US20160270789A1 (en) | 2016-09-22 |
| US10952731B2 (en) | 2021-03-23 |
| EP3065648A1 (en) | 2016-09-14 |
| AU2013403916A1 (en) | 2016-04-28 |
| WO2015065486A1 (en) | 2015-05-07 |
| CN105682567A (zh) | 2016-06-15 |
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