CN105832373B - 手术紧固件施加装置 - Google Patents
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Abstract
本公开涉及手术紧固件施加装置。本发明公开了一种发射组件,包括:静止外壳,包括具有底壁和一对侧壁的U形框架,所述静止外壳具有近侧部和远侧部;滑块,支撑在所述静止外壳的所述近侧部中;导块,支撑在所述静止外壳的所述远侧部中,所述导块限定多个狭槽;刀具致动杆,具有装至所述滑块的近侧部和定位在所述多个狭槽中的一个内的远侧部;凸轮杆,具有装至所述滑块的近侧部和延伸穿过所述多个狭槽中的一个的远侧部;以及枢转锁定构件,枢转地装在所述静止外壳的所述近侧部内,所述枢转锁定构件包括闩锁部并且被从未闩锁位置枢转到闩锁位置。
Description
本申请是申请号为201210192042.0、申请日为2012年06月11日、发明名称为“手术紧固件施加装置”的专利申请的分案申请。
本申请要求于2011年6月9日提交的序列号为61/494,985的美国临时专利申请的优先权,其全部内容通过引用合并于此。
技术领域
本公开涉及手术紧固件施加装置,尤其涉及具有可重复使用部件和一次性部件的手术紧固件施加装置。
背景技术
手术紧固件施加装置是本领域中公知的,其中首先将组织抓取或夹紧在相对的钳夹结构之间,然后通过手术紧固件连结组织。在某些此类装置中,设置有用于切割已经被紧固件连结的组织的刀具。紧固件通常为手术吻合钉的形式,但是也可以利用其他手术紧固件,例如夹子或两件式聚合物手术紧固件。
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在其间捕获或夹紧组织。通常,一个梁构件承载一次性钉仓组件,所述一次性钉仓组件容纳布置为至少两个横排的多个吻合钉,而另一个梁构件包括砧座,所述砧座限定有用于在从钉仓组件中驱出吻合钉时成形吻合钉钉腿的表面。如果使用两件式紧固件,则包括砧座的梁构件承载两件式紧固件的配合件,例如容纳件。通常,吻合钉成形过程会受到一个或多个纵向运动的凸轮构件和一系列单独的吻合钉推进器之间相互作用的影响。当凸轮构件沿纵向行进通过钉仓承载梁构件时,各单独的推进器构件向上偏置到支撑在钉仓组件内的吻合钉的后跨部,以从钉仓中按顺序弹出吻合钉。可以设置在吻合钉排之间与凸轮构件一起行进的刀具,以切割各排成形吻合钉之间的组织。第7,631,794号美国专利公开了此类器械的一个示例,该专利的全部内容通过引用合并于此。
由于存在与灭菌不适当关联的危险,手术紧固件施加装置通常是使用后可丢弃的。虽然可以更换钉仓组件以对单一患者执行多次紧固件施加操作,但是紧固件施加装置通常在已经完成手术操作后被丢弃。该用后即丢弃的要求会增加与手术操作关联的成本。尽管已经开发出可重复使用的紧固件施加装置,但是此类装置会过度复杂并且证实是难以灭菌的。
本领域需要这样一种紧固件施加装置:包括可重复使用的部件,结构并不过度复杂,并且被构造为便于在手术操作中使用后进行适当灭菌。
发明内容
本发明涉及用于将手术紧固件施加到组织的手术紧固件施加装置。在一个实施例中,所述装置包括砧座半部,砧座半部包括远侧砧座部和近侧手柄部。钉仓容纳半部限定有具有远侧部和近侧部的细长通道构件,所述远侧部被定尺寸为可释放地容纳一次性使用装载单元,而所述近侧部构造为支撑发射组件。夹紧操作杆装至所述钉仓容纳半部,包括近侧部、远侧部和支撑接合构件的手柄部。发射组件构造为可释放地支撑在所述钉仓容纳半部的近侧部内。所述发射组件包括静止外壳、发射操作杆、固定地装至所述发射操作杆的凸轮杆和具有闩锁部的枢转锁定构件。所述夹紧操作杆与所述砧座半部和所述钉仓容纳半部可操作地关联,并且能够从松开位置运动到夹紧位置,从而将所述砧座半部的砧座部可释放地装成紧邻所述一次性使用装载单元。在夹紧位置,所述夹紧操作杆的接合构件可释放地接合所述锁定构件的闩锁部,以使所述夹紧操作杆可释放地保持在夹紧位置。
在一个实施例中,所述接合构件包括圆柱形支柱,尽管也可以构想其他接合构件构造。在一个实施例中,所述闩锁部包括能够与所述夹紧操作杆的所述接合构件接合的钩状构件。所述锁定构件能够包括一对枢轴构件,所述枢轴构件枢转地支撑在所述发射组件的静止外壳的近端内限定的开口中。弹簧构件能够支撑在所述夹紧操作杆上,并定位成接合所述钉仓容纳半部以将所述夹紧操作杆驱动到所述松开位置。偏压构件能够被设置用于朝向所述静止外壳向内驱动所述闩锁部。
在一个实施例中,指状接合构件定位在所述锁定构件上,其中,压动所述指状接合构件能使所述闩锁部从所述夹紧操作杆的接合构件释放。所述指状接合构件能够定位在所述发射操作杆的近侧。在一个实施例中,所述指状接合构件定位在所述锁定构件的一端上,而所述闩锁部定位在所述锁定构件的另一端上。
在一个实施例中,所述闩锁部延伸穿过所述静止外壳的近端中的开口,并且位于所述细长通道构件的底面之下。
在一个实施例中,所述发射组件和一次性使用装载单元是一次性的,而所述砧座半部、钉仓容纳半部和夹紧操作杆是能够重复使用的。
在一个实施例中,所述细长通道构件具有用于容纳所述枢轴构件的第一切口和第二切口,以使所述发射组件可释放地装在所述通道构件的近侧部内。
所述静止外壳能够包括U形框架,所述U形框架包括底壁和一对侧壁,其中,每个侧壁均具有限定有开口的近端,而所述枢轴构件被定尺寸为延伸穿过所述开口以容纳在所述钉仓容纳半部的近端中形成的切口中,从而将所述静止外壳可释放地保持在所述细长通道构件的近侧部内。
所述发射组件能够包括轴向固定在所述U形框架内的导块和滑动地定位在U形框架中的滑块,其中,所述发射操作杆枢转地装至所述滑块,而所述凸轮杆固定地装至滑块,以使所述滑块能够滑动通过所述U形框架,从而推进所述凸轮杆通过所述细长通道构件的远侧部。所述发射组件能够进一步包括刀具致动杆,所述刀具致动杆构造为与支撑在一次性使用装载单元内的刀具接合。
所述钉仓容纳半部能够包括限定有凹部的侧壁,而所述夹紧操作杆能够包括限定有凸部的侧壁,其中,所述凸部能够定位在所述凹部内以保持所述夹紧操作杆。
在一个实施例中,所述夹紧操作杆可释放地装至所述钉仓容纳半部。
附图说明
现在将在此参照附图描述本公开的手术紧固件施加装置的各个实施例,其中:
图1为本公开的处于夹紧位置的手术紧固件施加装置的一个实施例从远端观察时的侧视立体图;
图2为处于夹紧位置的图1所示的手术紧固件施加装置从近端观察时的侧视立体图;
图2A为处于打开位置的图1所示的手术紧固件施加装置的侧视立体图;
图2B为图2A所示的细节表示区域的放大视图;
图3为图1所示的手术紧固件施加装置的部件分解的侧视立体图;
图3A为图1所示的手术紧固件施加装置的夹紧操作杆的侧视剖视图;
图4为图1所示的手术紧固件施加装置的钉仓容纳半部的侧视立体图,其中一次性使用装载单元和发射组件被支撑在钉仓容纳半部内;
图5为图4所示的细节表示区域的放大视图;
图6为SULU和发射组件被支撑在其中的手术紧固件施加装置的钉仓容纳半部的俯视立体图;
图7为图6所示的细节表示区域的放大视图;
图8为图3所示的手术紧固件施加装置的发射组件的前端俯视立体图;
图9为图8所示的细节表示区域的放大视图;
图9A为发射组件被可释放地装在其中的通道构件的俯视立体图;
图9B为图9A所示的细节表示区域的放大视图;
图9C为通道构件的中央部的俯视立体图;
图10为图8所示的发射组件的后端俯视立体图;
图11为图10所示的细节表示区域的放大视图;
图12为图10所示的发射组件的部件分解的侧视立体图;
图12A为图12所示的发射组件的凸轮杆的底视立体图;
图12B为图12所示的发射组件的发射操作杆的底视立体图;
图13为图1所示的手术紧固件施加装置的SULU的侧视立体图;
图14为图13所示的细节表示区域的放大视图;
图15为图13所示的SULU的前视立体图;
图16为图15所示的细节表示区域的放大视图;
图17为图15所示的SULU的部件分解的侧视立体图;
图18为处于打开位置的图1所示的手术紧固件施加装置的侧视剖视图;
图19为图18所示的细节表示区域的放大视图;
图20为图18所示的细节表示区域的放大视图;
图21为处于打开位置的图18所示的手术紧固件施加装置的近端的立体图;
图22为图18所示的细节表示区域的放大视图;
图23为图1所示的手术紧固件施加装置的夹紧操作杆的近端从下方观察时的立体图;
图24为处于夹紧位置的图1所示的手术紧固件施加装置的侧视立体图;
图25为处于夹紧位置的图24所示的手术紧固件施加装置的侧视剖视图;
图26为图25所示的细节表示区域的放大视图;
图27为图25所示的细节表示区域的放大视图;
图28为沿图26的剖切线28-28所截取的剖视图;
图29为在发射组件运动整个致动行程以从紧固件施加装置中弹出紧固件时图1所示的手术紧固件施加装置的顶视图;
图30为发射组件处于致动位置的图29所示的手术紧固件施加装置的侧视剖视图;
图31为图30所示的细节表示区域的放大视图;
图32为图30所示的细节表示区域的放大视图;
图33为在装置已经发射并运动到打开位置后的图1所示的手术紧固件施加装置的侧视剖视图;以及
图34为图33所示的细节表示区域的放大视图。
具体实施方式
现在将参照附图详细描述根据本公开的手术紧固件施加装置的实施例,其中相同的附图标记表示相似或相同结构的元件。如在此所使用的,按照惯例,术语“近侧”是指装置的较靠近使用者的一端,而术语“远侧”是指装置的较远离使用者的一端。
图1至图34示出了通常标识为手术吻合器10的本公开的手术紧固件施加装置的一个实施例。具体参照图1至图3,手术吻合器10包括砧座半部12、钉仓容纳(支撑)半部14、夹紧操作杆16、一次性使用装载单元或钉仓18(下文称为“SULU”)和发射组件20。在一个实施例中,砧座半部12、钉仓容纳半部14和夹紧操作杆16被构造为可重复使用的部件,由此,采用适于灭菌和重复使用的生物相容性材料构造而成,例如不锈钢。不同的是,SULU 18和发射组件20被构造为一次性的,由此,可以采用具有必需强度特性的任何适合的生物相容性材料构造而成,例如塑料、金属及其组合。SULU 18和发射组件20能够被可选择地构造为整体单元,以作为单一单元装载到钉仓容纳半部14中。
参照图3至图7,钉仓容纳半部14限定有细长通道构件22,细长通道构件22限定有大致U形的通道24,通道24具有远侧部24a和近侧部24b,远侧部24a被定尺寸为可释放地容纳SULU18,而近侧部24b被定尺寸为可释放地容纳发射组件20。发射组件20包括静止外壳26(另参见图12),静止外壳26的近端包括用于容纳枢轴构件29的端部的开口28。枢轴构件29枢转地支撑静止外壳26的近端上的锁定构件206,并且枢轴构件29通过开口28延伸到形成在钉仓容纳半部14的近侧部中的凹槽30(图3)中,从而将发射组件20的近端可释放地装到通道构件22的近侧部24b内,下面将进一步详细描述。发射组件20的远端限定三角形切口64d。切口64d定位成容纳形成在通道构件22的内壁上的凸部65(参见图9A至图9C),从而将发射组件20的远端可释放地装在通道构件22内。下面还将进一步详细地讨论发射组件20的结构。SULU 18包括一对远侧凸部32,所述一对远侧凸部32定位在形成于通道构件22的远端处的切口34中,从而可释放地将SULU 18装在通道构件22的远侧部24a内。在组装期间,在将SULU 18插入通道构件22的远侧部24a中之前,必须将发射组件20插入通道构件22的近侧部24b中,如下面将讨论的。为了将SULU 18定位在通道构件22中,将SULU 18上的凸部32定位在切口34内,同时SULU 18定位在通道构件22上方并与通道构件22成一角度。其后,能够将SULU 18向下旋转到U形通道24的远侧部24a中。这允许发射组件20的驱动部件与SULU 18的部件适当地对准,而且,有助于发射组件20与支撑在SULU 18内的刀具40(图17)接合。SULU18的近端包括向外延伸的锯齿面42(图7),以有助于抓握SULU 18的近端,从而允许从通道构件22中移除和/或更换SULU 18。在吻合器10运动到夹紧位置之前,锯齿抓握面42不会完全落入通道构件22的远侧部24a内,如下面将讨论的。
参照图8至图12,发射组件20包括静止外壳26、刀具致动杆44、凸轮杆46、导块48、发射操作杆50、滑块52、压板(pedal)54以及枢转锁定构件206(图12)。在一个实施例中,静止外壳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的远端限定近侧台阶64b、远侧倾斜部64c和三角形切口64d。如上所述,三角形切口64d定位成容纳形成在通道构件22的内壁上的凸部65(图9B)。每个侧壁64的近端包括一对横向延伸的可变形的壁部66(图11),壁部66与滑块52的近端隔开并且限定出壁部66与滑块52之间的区域以用于枢转地容纳锁定构件206,下面将进一步详细描述。
导块48包括限定有三个纵向狭槽70a-c的本体和一对向外延伸的凸部72。在一个实施例中,每个凸部72大致为圆柱形并包括锥形部72a(图9)。可选择地,可以构想其他凸部构造。凸部72被定尺寸为容纳在形成于静止外壳26的侧壁64中的开口74(图12)中,以使导块48沿轴向固定在静止外壳26的远端内。凸部72允许导块48在U形框架60内进行一定程度的枢转运动。如下面将进一步详细讨论的,作为对吻合器10到夹紧位置的运动的响应,导块48从与刀具致动杆44的凹口49和51锁定接合的第一位置(图19)枢转到与刀具致动杆44的凹口49和51分离的第二位置(图26)。扭转弹簧绕凸部72设置以驱动导块48与凹口49和51锁定接合。狭槽70a和70c中的每个都被定尺寸为可滑动地容纳凸轮杆46的相应侧壁114。同样地,狭槽70b被定尺寸为可滑动地容纳刀具致动杆44。
滑块52包括具有弹性指部80a的毂部80,弹性指部80a被构造为卡接到形成在发射操作杆50中的枢轴孔82中。当滑块52处于缩回位置以便于从吻合器10的任一侧致动发射组件20时,发射操作杆50围绕毂部80枢转。压板54被往复地容纳在形成于滑块52中的孔84内。压板54包括裂口式本体部54a,裂口式本体部54a被构造为横跨刀具致动杆44的近端102。在一个实施例中,裂口式本体部54a包括倾斜远侧面86。销88从压板54向上延伸穿过滑块52中的孔84。偏压构件90围绕销88定位在裂口式本体部54a和滑块52之间,以驱动压板54远离滑块52向下运动到延伸位置。在滑块52的缩回位置,压板54被容纳在形成于通道构件22的底壁22a中的切口55中。
发射操作杆50包括第一指状接合构件50a和第二指状接合构件50b,能够选择性地接合任一个指状接合构件,以使发射操作杆50从吻合器10的任一侧运动整个发射行程。弓形凹槽94(图12B)形成在发射操作杆50的底面中,用于可滑动地容纳压板54的销88,以限定发射操作杆50能够围绕滑块52的毂部80枢转的旋转范围。如本文所使用的,发射行程被限定为发射操作杆50从完全缩回位置(图25)到完全推进位置的运动(图30)。止动凹槽94a形成在弓形凹槽94的每一端部处。止动凹槽94a被构造并定尺寸为容纳压板54的销88的端部,以在手术吻合器10的发射行程期间防止发射操作杆50围绕毂部80的枢转运动。更具体地,当致动发射组件20以在静止外壳26内向远侧推进滑块52时,压板54的倾斜远侧面86与通道构件22接合并凸轮运动出切口55(图27),以向上驱动销88进入止动凹槽94a,从而在发射操作杆50的发射行程运动期间防止发射操作杆50的枢转运动。显然,销88必须定位在止动凹槽94a的下面,以允许压板54从切口55向上提升,从而允许发射操作杆50运动整个发射行程。因而,在发射操作杆50运动发射行程之前,必须先将发射操作杆50枢转到发射组件20的一侧或另一侧。
刀具致动杆44包括具有台阶部100的近端,台阶部100包括具有第一高度的近侧第一台阶102和具有第二高度的第二台阶104,第二高度大于第一高度。致动杆44的远端包括上翘钩部106和上下凹口49和51。指部108在第一台阶102和第二台阶104之间从刀具致动杆44向上凸出。如图27所示,指部108被可滑动地容纳在形成于滑块52的下侧的凹槽110内。当在静止外壳26内向远侧推进滑块52时,指部108在凹槽110内运动,以使滑块52相对于刀具致动杆44运动,直到指部108与限定凹槽110的近端的壁112(图32)接合。当指部108与壁112接合时,滑块52的进一步向远侧运动还将实现刀具致动杆44的向远侧运动。如下面将显而易见的,该配置允许在切割组织之前从SULU 18中弹出吻合钉。
参照图12和图12A,凸轮杆46包括一对侧壁114和底壁116。每个侧壁114的近端114a包括凸起的壁部118。每个凸起的壁部118被构造为固定地容纳在形成于滑块52的下侧的狭槽(未示出)中,以使凸轮杆46的近端固定地装到滑块52。可选择地,可以围绕刀具致动杆44的近端模制滑块52。每个侧壁114的远端包括倾斜凸轮面114b。底壁116限定有向远侧延伸的细长狭槽123和向近侧延伸的纵向狭槽121,细长狭槽123从凸轮杆46的远端沿凸轮杆46的大部分长度延伸。狭槽121定位成当滑块52处于缩回位置时,有助于使压板54穿过通道构件22的切口55(参见图27)。
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被支撑在通道构件22中并且发射操作杆50枢转到静止外壳26的一侧且被向远侧推动时,滑块52在静止外壳26内向远侧运动。随着滑块52开始向远侧运动,压板54的锥形面86与限定切口55的通道构件22的近侧边接合,以驱动压板54向上运动出切口55,穿过凸轮杆46的狭槽121,并且运动到发射组件20的静止外壳26的内表面上(图27)。这时,压板54的销88运动到止动凹槽94a中,以防止发射操作杆50的进一步枢转运动。如果发射操作杆50没有枢转到使得销88定位在止动凹槽94a的下面这样的位置,则会防止压板54向上运动出切口55,并将防止发射操作杆50运动发射行程。随着发射操作杆50向远侧运动,指部108在凹槽110内运动,以使刀具致动杆44在凸轮杆46向远侧推进时保持静止。当指部108与限定凹槽110的近侧壁112接合时,刀具致动杆44与滑块52和凸轮杆46一起向远侧运动。如下面将讨论的,当凸轮杆46和刀具致动杆44在发射组件20的静止外壳26和通道构件22内向远侧运动时,凸轮杆46的倾斜凸轮面114b运动通过SULU 18以从SULU 18中弹出紧固件。同时,虽然预设延迟等于凹槽110(图32)的长度,但是刀具致动杆44驱动刀片40通过SULU 18以切开组织。
第7,631,794号美国专利(“‘794专利”)公开了包括类似上述发射组件的发射组件的手术紧固件施加装置。‘794专利的全部内容通过引用合并于此。
图13至图17示出了SULU 18。参照图17,SULU 18包括本体120、多个吻合钉推进器122(仅示出一个)、底盖124、具有倾斜尖锐的前沿或刀片40a的刀具40、多个吻合钉126(仅示出一个)和枢转地安装的安全闭锁128。本体120的近端包括柔性指部120a,柔性指部120a略微凸出超过限定本体120的外壁(另请参见图5)。指部120a与通道构件22的内壁摩擦接合,以便在SULU 18可释放地定位在通道构件22内时,将SULU 18的近端保持在通道构件22内。在本领域中,已知本体120具有多排吻合钉保持狭槽130,例如4排、6排等,并且线性槽形刀具轨道132居中布置在本体120中。手术吻合器10能够被定尺寸为容纳或适应具有不同吻合钉行长(例如,60mm、80mm和100mm)的SULU。刀具40包括下翘钩部40b,下翘钩部40b定位成当SULU 18定位在通道构件22内时,与刀具致动杆44的上翘钩部106(图12)接合。
在示出的实施例中,本体120包括形成于线性槽形刀具轨道132的任一侧的两排交错槽130。各排交错槽130延伸超出刀具轨道132的远端,以利于吻合钉在刀片40的行程的远端以外成形。
吻合钉推进器122可以被构造为延伸到一个或多个狭槽130中。在一个实施例中,单个推进器与每个狭槽130关联。可选择地,如图17所示,每个推进器122能够被构造为延伸到两个相邻狭槽130中并定位于保持在狭槽130中的相应吻合钉126的下面。在本领域中,已知每个推进器122都包括下部凸轮面122a,下部凸轮面122a定位成与凸轮杆46的远端上的凸轮面114b(图12)中的一个接合,从而使凸轮杆46在SULU 18内的运动按顺序升高相应一个或多个狭槽130内的每个相应推进器122,以从一个或多个狭槽130中弹出吻合钉。
底盖124部分围绕形成在钉仓本体120内的通道125(图18)。纵脊134形成在底盖124的上表面上并为装于刀具40的底边的刀具支撑构件136提供支承面。通过销、焊接或其他已知的紧固技术,刀具40可以装于支撑构件136。在发射行程期间,随着发射操作杆50推进通过通道构件22,刀具40被沿着刀具轨道132引导。一对狭槽138限定在脊134的侧面和钉仓本体120的外壁之间。纵脊134定位在本体120内并被定尺寸为被可滑动地容纳在凸轮杆46的细长狭槽120(图12A)中,从而使凸轮杆46能够围绕纵脊134可滑动地运动通过钉仓本体120,以从SULU 18中弹出吻合钉126。
安全闭锁128枢转地布置在本体120的上部近端上,并围绕枢轴构件150从锁定方位(图26)枢转到解锁方位(图34)。枢轴构件150被容纳在本体120中的开口154中。偏压构件(例如弹簧152)定位在刀具支撑构件136和安全闭锁128之间,以朝向解锁方位驱动安全闭锁128。安全闭锁128包括近侧钩156,近侧钩156定位成当刀具40处于缩回位置(图19)时,容纳形成在刀具40上的接合构件158以使安全闭锁128保持在锁定方位。当在发射行程期间刀具40朝向推进位置运动时,接合构件158移离近侧钩156,以允许安全闭锁128响应弹簧152的驱动而朝向解锁位置枢转。需要注意的是,当砧座半部12和钉仓容纳半部14处于夹紧位置时,防止了安全闭锁128枢转到解锁位置,因为安全闭锁128的顶面128a与砧座半部12的内表面接合,以防止安全闭锁128的枢转。安全闭锁128限定有狭槽160,狭槽160被定尺寸为可滑动地容纳刀具40。在刀具40的缩回位置处,刀具40的前沿40a被限制在安全闭锁128的狭槽160内,以防止由于刀具40的前沿40a引起的意外接合和对医务人员的伤害。
再次参照图2至图3,砧座半部12包括近侧手柄部12a和远侧砧座部12b。砧座部12b包括吻合钉变形部198,在本领域中,已知吻合钉变形部198包括多个吻合钉变形凹槽并在SULU 18位于通道构件22中时面向SULU 18的顶面。在本领域中,还已知吻合钉变形部198包括中央纵向狭槽(未示出),用于当刀具40运动通过SULU 18时容纳刀具40。吻合钉变形部198能够与砧座半部12一体成形,或者在替换方案中通过紧固处理(如焊接)装于砧座半部12。一对定位指部170(图3)定位在砧座部12b的吻合钉变形部198的近端附近。定位指部170容纳在SULU18中的槽中,从而当该装置处于夹紧位置时使得SULU 18与吻合钉变形部198适当地对准。
砧座半部12的中央部包括一对圆柱形横向支撑构件172。在砧座半部12和钉仓容纳半部14的组装期间,横向支撑构件172被支撑在限定于钉仓容纳半部14的中央部173(图28)中的U形凹槽174中。中央部173的远侧壁限定组织止动部(图3)。横向支撑构件172还定位成当夹紧操作杆16运动至夹紧位置时,被容纳在形成于夹紧操作杆16的间隔的凸缘部178上的切口176中。近侧手柄部12a人体工学地形成,并包括拇指接合邻接部180和抓握部182。手柄部12a的近端包括向下延伸的指部184,指部184包括一对相对的泪滴状凸部186,下面将进一步详细讨论。可选择地,凸部186可以采取各种构造。
钉仓容纳半部14包括在中央间隔布置的U形凹槽174,而U形凹槽174定位成支撑砧座半部12的横向支撑构件172。钉仓容纳半部14的近端包括一对垂直支撑构件188。每个垂直支撑构件188都包括具有圆形底面的细长垂直狭槽188a。垂直狭槽188a被定尺寸为在组装期间当砧座半部12被支撑在钉仓容纳半部14上时,容纳形成在砧座半部12的指部184(图21)上的凸部186。通过将凸部186定位在垂直狭槽188a内,砧座半部12能够以剪刀式方式在打开位置和闭合位置之间相对于钉仓容纳半部14枢转。在一个实施例中,凸部186具有泪滴状轮廓。钉仓容纳半部14的至少一个侧壁包括凹部189(参见图3),下面将进一步详细讨论。
夹紧操作杆16还包括具有抓握部190a的手柄部190和拇指接合邻接部192。如上面所讨论的,一对间隔的凸缘部178被支撑在夹紧操作杆16的远端上。每个凸缘部178都限定有切口176,切口176被定尺寸为当吻合器10朝向夹紧位置运动时(图2B),容纳砧座半部12的相应横向支撑构件172。夹紧操作杆16的远端还限定有一对开口194,所述一对开口194被定尺寸为容纳枢轴构件187。枢轴构件187定尺寸为延伸穿过钉仓容纳半部14中的开口195和夹紧操作杆16中的开口194,从而将夹紧操作杆16枢转地装于钉仓容纳半部14。
如图3A所示,夹紧操作杆16的内壁包括凸部201。凸部201定位在形成于钉仓容纳半部14的侧壁中的凹部189(图2A)内,从而可分离地保持夹紧操作杆16,以允许夹紧操作杆16逆时针(如从图3的方位观察)运动到用于清洁的倾斜位置,和/或如下文所述的能够与钉仓容纳半部14分离的位置。
为了将发射组件20装载到通道构件22的近侧部24b中,发射组件20的静止外壳26通过通道构件22的近端滑动进入通道构件22,直到枢轴构件29容纳在形成于通道构件22的近端中的凹槽30内。在装载发射组件20之后,SULU 18能够以上述方式装载到远侧部24a中。
参照图2和图2B,在SULU 18和发射组件20装载到通道构件22中后,能够将砧座部12组装到钉仓容纳半部14。为了将砧座半部12联接到钉仓容纳半部14,将指部184的凸部186定位在钉仓容纳半部14的垂直支撑构件188的垂直狭槽188a中。其后,朝向钉仓容纳半部14旋转砧座半部12,以使横向支撑构件172定位在U形凹槽174中。
为了将手术吻合器10定位在夹紧位置,从图2A所示的位置沿逆时针方向旋转夹紧操作杆16。随着夹紧操作杆16的旋转,横向支撑构件172被容纳在凸缘部178的切口176(图2)中,并朝向钉仓容纳半部14做凸轮运动。如图3所示,弹簧构件200装于夹紧操作杆16的内表面的某一位置,如通过焊接,以与钉仓容纳部14接合,从而将夹紧操作杆16驱动到图2A所示的松开位置。在图1所示的夹紧位置处,吻合钉变形部198定位成紧邻SULU 18的顶面。
参照图3、图3A和图12,如上所述,枢转锁定构件206枢转地支撑在发射组件20的静止外壳26的近端上。枢转锁定构件206包括枢轴构件29,枢轴构件29延伸穿过静止外壳26内限定的开口28。指部接合构件212定位在锁定构件206的一端上,而闩锁部210定位在锁定构件206的另一端上。闩锁部210包括钩状构件210a。偏压构件214围绕枢轴构件29定位,以驱动闩锁部210向内朝向发射组件20的静止外壳26。当锁定构件206装在发射组件20上时,闩锁部210向下延伸穿过静止外壳26的近端中的开口28以定位在通道构件22(图20)的底面之下。如上所述,枢轴构件29的端部容纳在形成于钉仓容纳半部14的近端中的切口30内,从而将发射组件20可释放地装在通道构件22(图21)的近侧通道部24b内。切口30由下翘指部220部分地限定,以使发射组件26保持在通道构件22(图3)内。
参照图3A,夹紧操作杆16的近端包括接合构件,例如圆柱形横向支柱218,该接合构件定位成当夹紧操作杆16运动到夹紧位置时,与闩锁部210的钩状构件210a接合(图27)。尽管示出了支柱,但是可以构想其他接合构件构造。如图27所示,随着夹紧操作杆16朝向夹紧位置运动,闩锁部210的倾斜面222与支柱218接合。这种接合使得锁定构件206围绕枢轴构件29枢转,以使闩锁部210的钩状构件210a穿过然后与支柱218卡接。为了使闩锁部210从支柱218释放,压动锁定构件206的接合构件212以使闩锁部210枢转脱离支柱218。这时,弹簧构件200将夹紧操作杆16驱动到松开位置。
参照图3、图12、图19和图26,如上面所讨论的,导块48被枢转地支撑在发射组件20的静止外壳26中。导块48包括向远侧延伸的鼻部220(图12和图26),鼻部220在SULU 18被支撑在通道构件22中时安置在SULU 18下面。导块48的内表面包括锁定面222(图19),锁定面222在吻合器10处于松开位置时被容纳在刀具致动杆44的凹口49和51中。当SULU 18定位在通道构件22中时,在将夹紧操作杆16运动到夹紧位置之前,SULU 18定位在鼻部220上面并且没有完全落入通道构件22中,如上面所讨论的。当吻合器10运动到夹紧位置时,定位指部170(图3)与SULU 18的本体120的顶面接合,以使SULU 18完全落入通道构件22中。如上所述,定位指部170被容纳在SULU 18的槽中,以使SULU 18相对于砧座部12b适当地定位。随着SULU 18完全落入通道构件22中,SULU 18向下挤压导块48的鼻部220,以使导块48围绕凸部72枢转。当导块48枢转时,锁定面222运动出凹口49和51以解锁刀具致动杆44(图26)。该构造防止了在夹紧之前刀具致动杆44相对于导块48的运动,以确保刀具致动杆44和SULU刀具40在使用之前为了操作接合而保持适当的定位。
参照图24至图28,当吻合器10处于夹紧、非发射位置时,发射组件20的滑块52处于位于通道构件22和静止外壳26的近端处的缩回位置。参见图27。在此位置处,压板54定位在通道构件22的切口55中,而压板54的销88定位在发射操作杆50的弓形凹槽94中、止动凹槽94a下面。这样,发射操作杆50能够枢转以便于从吻合器10的任一侧致动吻合器10。此外,在滑块52的此位置处,刀具致动杆44的指部108定位在滑块52的凹槽110的远侧壁附近。锁定构件206的闩锁部210也与支柱218接合,以使夹紧操作杆16保持在夹紧位置。
参照图26,当滑块52处于缩回位置时,刀具40和凸轮杆46的凸轮面114b定位在SULU 18的近端处,而安全闭锁128的近侧钩156定位为与刀具40的接合构件158接合,以使安全闭锁128保持在锁定方位。此外,刀具40的下翘钩部40b与刀具致动杆44的上翘钩部106接合,以使发射组件20连接至SULU 18的刀具40。
参照图29至图32,当发射操作杆50沿图29中箭头“A”指示的方向朝向远侧推进时,滑块52在发射组件20的静止外壳26内向远侧运动,以实现凸轮杆46的对应运动和刀具致动杆44的延迟运动。如上面所讨论的,刀具致动杆44的延迟运动等于滑块52的凹槽110的长度,并由刀具致动杆44的指部108在滑块52的凹槽110内的运动引起。当指部108邻接凹槽110的近侧壁112时,刀具致动杆44与滑块52开始一起运动。随着凸轮杆46向远侧运动通过发射组件20的静止外壳26,凸轮杆46的侧壁114上的凸轮面114b被推进通过SULU 18,从而按顺序与推进器122接合,以从本体120的狭槽130中弹出吻合钉126。结果,由于刀具致动杆44的远端与刀具40接合,刀具40在预设延迟后被推进通过SULU 18以在吻合钉行之间切割组织。
如图32中的虚线所示,当滑块52在静止外壳26内向远侧运动时,压板54架置在通道构件22上方并沿着发射组件20的静止外壳26的内表面运动。这时,压板54的销88运动到止动凹槽94a中,以防止发射操作杆50的进一步枢转运动。
参照图31和图32,当刀具40在SULU 18内向远侧运动时,刀具40的接合构件158与安全闭锁128的近侧钩156分离。
参照图33和图34,当将发射操作杆50返回到其最近侧位置以缩回凸轮杆46和刀具40时,并且锁定构件206受压以使闩锁部210与支柱218分离时,弹簧200将夹紧操作杆16驱动到其松开位置,以允许吻合器10运动到打开位置。在打开位置,砧座半部12与钉仓容纳半部14间隔开,而弹簧152(图17)使安全闭锁128沿图34中箭头B指示的方向围绕枢轴构件150枢转到其解锁位置,以使安全闭锁128从SULU 18向上凸出。在解锁位置,安全闭锁128防止吻合器10运动回到夹紧位置。为了重复使用吻合器10,必须使用新的SULU 18更换已使用的SULU 18。
在手术操作期间,能够多次更换SULU 18以便对单个患者多次使用吻合器10。如果提供了整体单元,则能够多次更换SULU和发射组件。由于每个SULU 18都设置有新刀具40,因此使得组织撕裂最小化。在手术操作后,可以从通道构件22中移除已经使用的SULU 18和发射组件20,并以合适的方式进行处理。现在可以将砧座半部12、钉仓容纳半部14和夹紧操作杆16进行灭菌,例如通过高压蒸气进行灭菌,并且按照上述方式与新的SULU 18和发射组件20一起重复使用。因为锁定构件206形成发射组件20的一部分并且是一次性构件,所以可重复使用部件上截留组织和体液的区域较少。由此,该装置的可重复使用部件能够更加容易地灭菌。注意,在清洁/灭菌时,夹紧操作杆16能够从图2A的位置顺时针旋转,以使凸部201脱离钉仓容纳半部的凹部189,并且使夹紧操作杆16相对于钉仓容纳半部14运动到更大的角度,例如大约90°或者甚至是钝角。这有利于清洁/灭菌。在一些实施例中,一旦旋转脱离凹部189,夹紧操作杆16能够与钉仓容纳半部14分离。
应该理解的是,可以对本公开的手术紧固件施加装置的实施例进行各种改进。因此,上述描述不应被理解为限制,而是仅为实施例的范例。本领域的技术人员可以设想出在本公开的范围和精神之内的其他改进。
Claims (14)
1.一种发射组件,包括:
静止外壳,包括具有底壁和一对侧壁的U形框架,所述静止外壳具有近侧部和远侧部,并且配置为容纳在手术吻合器的钉仓容纳半部的通道构件中,所述通道构件包括远侧部,所述通道构件的远侧部被配置为容纳单个使用装载单元;
滑块,支撑在所述静止外壳的所述近侧部中;
导块,支撑在所述静止外壳的所述远侧部中,所述导块限定多个狭槽;
刀具致动杆,具有装至所述滑块的近侧部和定位在所述多个狭槽中的一个内的远侧部;
凸轮杆,具有装至所述滑块的近侧部和延伸穿过所述多个狭槽中的一个的远侧部;以及
枢转锁定构件,枢转地装在所述静止外壳的所述近侧部内,所述枢转锁定构件包括闩锁部并且能够被从未闩锁位置枢转到闩锁位置。
2.根据权利要求1所述的发射组件,进一步包括偏压构件,其定位成朝向所述闩锁位置驱动所述枢转锁定构件。
3.根据权利要求1所述的发射组件,其中,所述枢转锁定构件包括一对枢轴构件并且所述静止外壳限定开口,所述枢轴构件被容纳在所述开口内以将所述枢转锁定构件枢转地装至所述静止外壳。
4.根据权利要求1所述的发射组件,其中,所述闩锁部包括钩状构件。
5.根据权利要求2所述的发射组件,进一步包括支撑在所述滑块上的发射操作杆。
6.根据权利要求5所述的发射组件,进一步包括定位在所述枢转锁定构件上的指状接合构件,其中压动所述指状接合构件以使所述枢转锁定构件逆着所述偏压构件的驱动朝向所述未闩锁位置枢转。
7.根据权利要求6所述的发射组件,其中,所述指状接合构件定位在所述发射操作杆的近侧。
8.根据权利要求6所述的发射组件,其中,所述指状接合构件定位在所述枢转锁定构件的一端上并且所述闩锁部定位在所述枢转锁定构件的另一端上。
9.根据权利要求1所述的发射组件,其中,所述枢转锁定构件在所述静止外壳的所述底壁之下延伸。
10.根据权利要求9所述的发射组件,其中,所述静止外壳的所述近侧部限定开口并且所述枢转锁定构件延伸穿过所述开口。
11.根据权利要求1所述的发射组件,其中,所述枢转锁定构件包括一对枢轴构件并且所述静止外壳的所述侧壁限定开口,所述枢轴构件被枢转地支撑在所述开口中。
12.根据权利要求1所述的发射组件,其中,所述滑块能够滑动通过所述静止外壳的所述U形框架,从而推进所述凸轮杆通过所述静止外壳。
13.根据权利要求5所述的发射组件,其中,所述滑块包括毂部并且所述发射操作杆枢转地支撑在所述毂部上。
14.根据权利要求1所述的发射组件,其中,所述凸轮杆包括侧壁,每个所述侧壁延伸穿过所述导块的所述多个狭槽中的一个。
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US20160157860A1 (en) | 2016-06-09 |
CN102860851B (zh) | 2016-06-01 |
EP2532312A2 (en) | 2012-12-12 |
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US9289209B2 (en) | 2016-03-22 |
US10278696B2 (en) | 2019-05-07 |
EP2532312B1 (en) | 2016-12-28 |
CA2777988A1 (en) | 2012-12-09 |
US20120312861A1 (en) | 2012-12-13 |
CN105832373A (zh) | 2016-08-10 |
EP2532312A3 (en) | 2014-10-15 |
EP3155988A1 (en) | 2017-04-19 |
CN102860851A (zh) | 2013-01-09 |
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