CN107049397B - 带有小直径内窥镜部的手术吻合器 - Google Patents

带有小直径内窥镜部的手术吻合器 Download PDF

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CN107049397B
CN107049397B CN201710073131.6A CN201710073131A CN107049397B CN 107049397 B CN107049397 B CN 107049397B CN 201710073131 A CN201710073131 A CN 201710073131A CN 107049397 B CN107049397 B CN 107049397B
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assembly
diameter portion
surgical stapler
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斯坦尼斯瓦夫·马尔奇克
厄尼·阿兰依
斯坦尼斯洛娃·科斯切夫斯基
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Covidien LP
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    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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Abstract

一种带有小直径内窥镜部的手术吻合器，手术吻合器包括主体部和工具组件。所述主体部包括大直径部和从所述大直径部向远侧延伸的小直径部。所述大直径部支撑装置的较大内部组件以允许装置的小直径部的直径最小化，从而便于所述吻合器的所述小直径部和所述工具组件穿过8mm套管针，其中所述装置包括适于防止所述吻合器的再次发射的锁定组件。

Description

带有小直径内窥镜部的手术吻合器
技术领域
本公开涉及手术吻合器，并且更具体地，涉及适合于实施尤其包括儿科手术操作和胸科手术操作的内窥镜手术操作的，包括小直径内窥镜部的内窥镜手术吻合器。
背景技术
本领域中熟知实行组织的同步解剖和缝合的手术吻合器。手术吻合器的出现提升了组织缝合的速度并因此提升了减轻患者创伤的手术操作的速度。
用于通过皮肤中的小切口或通过插管内窥式地缝合组织的内窥镜手术吻合器在本领域中也被熟知。通过皮肤中的小切口内窥式地缝合组织而不是通过实施打开式手术操作也降低了患者创伤。
典型的内窥镜手术吻合器包括支撑工具组件的细长体。该细长体和工具组件(内窥镜部)被定尺寸为穿过皮肤中的小切口或插管。使细长体和工具组件的尺寸最小化有益于最小化对患者的创伤。因此，对适合于内窥镜用途的小直径手术吻合器存在持续的需求。
发明内容
依照本公开，提供了一种包括内窥镜部的手术吻合器，所述内窥镜部具有减小直径的远侧端部以便于内窥镜部插入通过小直径套管针组件。在实施例中，内窥镜主体部包括主体部和工具组件。所述主体部具有大直径部和小直径部，其中所述大直径部的直径大于所述小直径部的直径。所述小直径部从所述大直径部向远侧延伸并且所述工具组件被支撑在所述大直径部的远侧端上。在实施例中，手术吻合器的较大内部组件(与手术吻合器的其他内部组件相比)(包括例如锁定组件)，容纳在所述主体部的大直径部中，使得所述小直径部的直径能够最小化以便于所述小直径部和所述工具组件穿过小直径套管针组件，例如8mm套管针组件。
在本公开的一个方案中，手术吻合器包括致动装置和可释放地固定到致动装置的再装载器。所述再装载器包括主体部和工具组件。所述主体部包括大直径部和从所述大直径部向远侧延伸的小直径部。所述工具组件被支撑在所述小直径部的远侧端上并被定尺寸为穿过8mm套管针。
在实施例中，所述手术吻合器包括驱动组件，并且所述工具组件包括砧座组件和支撑多个吻合钉的钉仓组件，其中所述驱动组件能够运动通过所述主体部和所述工具组件以从所述钉仓组件中射出吻合钉。
在一些实施例中，细长体从所述致动装置向远侧延伸且所述再装载器被支撑在所述细长体的远侧端上。
在某些实施例中，包括锁紧构件的锁紧组件被支撑在所述主体部的所述大直径部内。
在实施例中，所述再装载器的主体部的大直径部包括壳体，并且所述锁紧构件被支撑在壳体内且能够从第一位置向第二位置运动，在所述第一位置所述锁紧构件结合所述驱动组件并保持所述驱动组件处于缩回位置，在所述第二位置所述锁紧构件允许所述驱动组件相对于壳体部向远侧运动。
在一些实施例中，锁定组件包括安装在所述再装载器的大直径部附近的能旋转套筒。所述能旋转套筒与所述锁紧构件接合以使得所述能旋转套筒的对于所述再装载器的大直径部的旋转引起所述锁紧构件从所述第一位置向所述第二位置运动。
在某些实施例中，所述能旋转套筒限定有凸轮槽且所述锁紧构件包括被接收在所述凸轮槽中的凸轮指状物，其中所述能旋转套筒的对于所述再装载器的大直径部的旋转使所述能旋转套筒接合所述凸轮指状物以使所述锁紧构件从所述第一位置向所述第二位置运动。
在实施例中，所述锁紧构件包括被定位为阻挡所述驱动组件从所述缩回位置向远侧运动的阻止指状物。
在一些实施例中，所述驱动组件包括近侧驱动构件，所述致动装置包括控制杆，并且所述近侧驱动构件支撑位于近侧主体部的大直径部内的连接器，其中所述连接器被构造为可释放地接合所述控制杆以将所述控制杆的运动转化为所述近侧驱动构件的运动。
在某些实施例中，所述驱动组件包括动态夹紧构件，其被定位为移动通过所述工具组件以从所述钉仓组件中射出多个吻合钉。
在实施例中，钉仓组件包括钉仓主体，所述钉仓主体限定有刀槽和在所述刀槽的每一侧的两排吻合钉。
在实施例中，所述钉仓主体在所述刀槽的每一侧支撑一排推进器。
在实施例中，解剖尖端被支撑在钉仓组件的远侧端上。
在实施例中，支撑件材料被支撑在所述砧座组件上。
附图说明
在此参照附图描述了本公开的带有小直径内窥镜部的手术吻合器的不同实施例，其中：
图1A是本公开的带有小直径内窥镜部的手术吻合器的一个实施例的侧视立体图，该手术吻合器包括支撑在致动装置上的吻合器再装载器和处在非关节式运动位置的吻合器再装载器的工具组件；
图1B是本公开的带有处在关节式运动位置的工具组件的再装载器的侧视立体图；
图2是图1B中所示的指示区域的细节放大图；
图3是从本公开的带有处在打开位置的工具组件的再装载器的下方看去的侧视立体图；
图4是从本公开的带有处在夹紧位置的工具组件的再装载器的上方看去的侧视立体图；
图5是图1B中所示的再装载器的分解立体图；
图6是图5中所示的指示区域的细节放大图；
图7是图5中所示的指示区域的细节放大图；
图7A是图5中所示的再装载器的推进器的侧视立体图；
图8是图1B中所示的再装载器的近侧端的侧视立体图；
图9是沿图4的剖面线9-9截取的剖面图；
图10是图1B中所示的再装载器的工具组件的钉仓组件和驱动组件的侧视立体图，其中钉仓主体以虚线示出；
图11是图1B中所示的再装载器的钉仓组件的侧视立体图；
图12是图1B中所示的再装载器的砧座的侧视立体图；
图13是本公开的带有小直径内窥镜部的手术吻合器的另一实施例的侧视立体图，该手术吻合器包括处在非关节式运动位置的工具组件；
图14是图13中所示的手术吻合器的工具组件的分解视图；
图15是图13中所示的指示区域的细节放大图；
图16是图13中所示的手术吻合器的工具组件的侧视立体图，其中钉仓组件的钉仓与通道分离；
图17是图13中所示的手术吻合器的工具组件的侧视立体图，其中该工具组件处在打开位置；以及
图18是沿图17的剖面线18-18截取的剖面图。
具体实施例
现将参照附图详细描述本公开的带有小直径内窥镜部的手术吻合器的实施例，其中相同的附图标记在若干视图的每一幅中指代等同或相应的元件。在本说明书中，术语“近侧的”通常用于指装置的更靠近临床医生的部分，而术语“远侧的”通常用于指吻合器的更远离临床医生的部分。此外，术语“内窥镜的”通常用于指通过小切口或插入患者体内的插管而执行的手术操作，其包括内窥镜、腹腔镜和关节镜手术操作。最后，术语临床医生通常用于指包括医生、护士和辅助人员的医疗人员。
图1A示出了本公开的包括小直径再装载器(总体示出为10)的手术吻合器2的一个实施例。手术吻合器2包括手柄组件或致动装置4、限定纵向轴线的细长体6以及再装载器10。细长体6被支撑在致动装置4上并从致动装置4向远侧延伸，手术吻合器再装载器10被支撑在细长体6的远侧端上。替换地，可想到细长体6和再装载器10可一体地形成，使得再装载器10不可释放地支撑在手术吻合器2的细长体6上，或者形成手术吻合器2的细长体6的整体延伸。
参照图1B-图4，手术吻合器再装载器10包括主体部12、装配组件14(图2)以及工具组件16。主体部12限定了与细长体6的纵向轴线对准的纵向轴线并具有联接部18(图1B)、大直径部20以及内窥镜部或小直径部22。大直径部的直径大于小直径部的直径。在实施例中，如下文详述的那样，再装载器10的小直径部22被定尺寸为接收在8mm套管针组件(未示出)中，而大直径部20的直径约为12mm且被定尺寸为支撑连接器和锁定组件。
工具组件16包括砧座组件24和钉仓组件26。钉仓组件26相对于砧座组件24被枢转地支撑并且可在打开外置(图2)与靠近或接近位置(图4)之间运动。装配组件14被支撑在主体部12的远侧端上且枢转地支撑工具组件16以便于工具组件16在关节式运动位置(图1B)和图4中所示的非关节式运动位置之间绕垂直于主体部12的纵向轴线的轴线进行关节式运动，如将在下文进一步详细讨论的。
在实施例中，组织解剖器30(图2)被固定至砧座组件24的远侧端。组织解剖器30具有锥形构造且从钉仓组件26的远侧端向远侧延伸以允许工具组件16在邻近手术部位的组织附近被操纵。替换地，组织解剖器30可附接至钉仓组件26。此外，正如本领域中已知的那样，砧座组件24可包括支撑件材料32以强化正被缝合和解剖的组织。
参照图5和图6，再装载器10的主体部12的大直径部20包括内壳体，其包括上半部分壳体34a和下半部分壳体34b。上半部分壳体34a和下半部分壳体34b限定了滑动地接收近侧驱动构件38和第一关节式运动连杆40的沟槽。上半部分壳体34a包括凹部(未示出)，其接收形成在下半部分壳体34b上的突起36(图6)以在半部分34a和34b之间联接并保持对准。半部分壳体34a和34b被接收在防止半部分34a和34b分离的近侧主体管42内。
下半部分壳体34b的近侧端限定了联接部18并包括接合凸起物140，接合凸起物140用于以卡口式联接布置可释放地接合手术吻合器2的致动装置4的主体部6(图1)的远侧端。对该结构更详细的描述，参见通过引用其全部内容合并于此的美国专利第5,865,361号(“‘361专利”)。
近侧驱动构件38具有细长体44，细长体44包括由支撑连接器48的间隔柔性支腿46限定的近侧部。连接器48构造为可释放地接合致动装置4的控制杆(未示出)以将控制杆的运动转化为近侧驱动构件38的运动。连接器48枢转地支撑作用为在再装载器10被发射后锁定再装载器10的锁定组件50。连接器48、控制杆(未示出)以及锁定部件50的细节在‘361专利中描述。通过使再装载器10设置有大直径部20以容纳连接器48和锁定部件50以及下文描述的吻合器2的其它部件，小直径部22的直径可被最小化至，例如，约8mm，使得其能够被接收在8mm套管针组件内。大直径部20的直径可约为12mm以上。
近侧驱动构件38的远侧端包括钩状部52，其与驱动组件56的钩状近侧端接合以使得如下文详细描述的那样近侧驱动构件38的向远侧运动引起驱动组件56的向远侧运动。
还参照图7，第一关节式运动连杆40(图6)具有钩状近侧端58，其构造为当再装载器10固定至致动装置4时与致动装置4的关节式运动轴(未示出)相接合。第一关节式运动连杆40的远侧端与第二关节式运动连杆60的近侧端相接合，第二关节式运动连杆60可滑动地定位在主体部12的小直径部22内。如图7所察看到的并如下面进一步详细描述的那样，第二关节式运动连杆60的远侧端通过在偏离于主体部12的纵向轴线的位置处的销60a(图7)枢转地连接至装配组件14，使得第二关节式运动连杆60的纵向运动引起工具组件16绕垂直轴线枢转运动。
主体部12的小直径部22包括内主体，其包括接收在外管66内的上半部分64a和下半部分64b(图5)。上半部分64a和下半部分64b限定了滑动地接收近侧驱动构件38、驱动组件56和第二关节式运动连杆60的沟槽(未示出)。上半部分64a和下半部分64b的远侧端还限定了将在下文详述的阶梯状切口70。
参照图7至图9，工具组件16包括砧座组件24和钉仓组件26。砧座组件24包括砧座主体72和固定至砧座主体72的下侧以限定通道76的砧座板74(图9)。在实施例中，解剖器尖端30被支撑在砧座板74的远侧端上。砧座板74限定了多个吻合钉接收凹陷72a(图9)和纵向槽78，纵向槽78被定尺寸为可滑动地接收再装载器10的驱动组件56的工作端80(图7)的一部分，如下面进一步详述。砧座主体72的近侧端包括托架82，托架82限定了用于接收装配组件14的圆柱状枢转构件84的孔82a。
在一些实施例中，钉仓组件26包括通道90和钉仓主体92。钉仓主体92通过搭扣配合连接而附接到通道90。更具体地，钉仓主体92包括一系列突起96，其被接收在限定于通道90的侧壁中的开口98内，以将钉仓主体92固定在通道90内。突起96可具有允许突起96越过通道90的侧壁并进入开口98中的锥形侧壁以及水平上表面，从而将突起96保持在开口98内以防止钉仓主体92与通道90偶然分离。
通道90通过分别延伸通过在砧座主体72和通道90中形成的开口102和104的枢转构件100而枢转地固定至砧座主体72。钉仓主体92可以在刀槽106的每一侧均仅限定两排吻合钉保持槽104以便减小工具组件16的直径。如下所述，刀槽106与在通道90中限定的细长槽106a(图9)对准以便于动态夹紧构件通过。吻合钉保持槽104沿钉仓主体92的组织接触面110定位并与砧座板74的吻合钉形成凹陷72a(图9)对准。每个槽104构造为接收紧固件或吻合钉112和推进器114。致动滑块116被定位为纵向地穿过钉仓主体92至与推进器114接合以从钉仓主体92中顺序地射出吻合钉112。
装配组件14包括上装配部分120和下装配部分122。装配部分120和122中的每一个均包括枢转构件84。如上所述，枢转构件84被接收在形成于砧座主体72的近侧端上的托架82(图7)的孔82a内以将上装配部分120固定至砧座主体72。第一联接构件126具有限定了开口126a的第一端和接收在凹部70内的第二端，其中开口126a还接收枢转构件82a，凹部70被限定在再装载器10的主体部12的上半部分64a的远侧端中。枢转构件82还被支撑在下装配部分122上并被接收在于第二联接构件128的第一端中限定的开口128a中。第二联接构件128具有被接收在于主体部12的下半部分壳体64b中限定的凹部70内的第二端以将下装配部分122枢转地固定至再装载器10的主体部12的下半部分壳体64b。枢转构件100延伸穿过于砧座主体72中形成的开口102和于通道90中形成的开口105并被接收在形成于下装配部分122中的开口130(图7)中以将下装配部分122固定至通道90。上装配部分120和下装配部分122利用销或铆钉134固定在一起。
如上所述，第一关节式运动连杆40可释放地联接至致动装置4的关节式运动机构以控制工具组件16的关节式运动。更具体地，当致动装置4的关节式运动机构(未示出)被操作时，第一关节式运动连杆40被推进以引起第二关节式运动连杆60相应地推进。第二关节式运动连杆60的远侧端在偏离于由枢转构件84限定的轴线的位置处连接至上装配部分120。这样，第二关节式运动连杆60的纵向运动引起工具组件16绕由枢转构件84限定的轴线枢转。
还参照图5，在实施例中，驱动组件56由弹性材料的多个叠片140a-140c构成，弹性材料例如为不锈钢、弹簧钢。材料片140a-140c的近侧端被接收在例如片状金属夹142的夹的细长凹部142a内。尽管允许一定程度的相对纵向运动，但金属夹142保持片140a-140c中的每一个的近侧端的对准。驱动组件56的材料片140a-140c的每一个的远侧端诸如通过焊接被固定至动态夹紧构件150。金属夹142和片140a-140c的近侧端为钩型并接合近侧驱动构件38的钩状部52，使得近侧驱动构件38的纵向运动引起驱动组件56的纵向运动。
如图7最佳所示，包括动态夹紧构件150的驱动组件56的工作端80也限定了刀152。刀152被支撑或形成在动态夹紧构件150的垂直支杆154上。动态夹紧构件150包括上凸缘156和下凸缘158。上凸缘156被定位为可滑动地被接收在砧座组件24的通道76(图9)内且下凸缘158被定位为可滑动地沿钉仓组件26的通道90的外表面90a(图9)定位。驱动组件56的向远侧运动首先推进下凸缘158至与在通道90上形成的凸轮表面160接合以使钉仓组件26朝向砧座组件24枢转至靠近或接近位置。之后，随着动态夹紧构件150运动通过工具组件16，驱动组件56的推进渐进地保持砧座组件24和钉仓组件26之间的最小组织间隙邻近动态夹紧构件150。
滑块116在紧接动态夹紧构件150的远侧的位置处被支撑在钉仓主体92内。动态夹紧构件150的远侧端定位为接合并驱动滑块116通过钉仓组件26的钉仓主体92。滑块116包括第一凸轮构件166和第二凸轮构件168，第一凸轮构件166和第二凸轮构件168定位为接合位于钉仓组件26内的推进器114以从钉仓主体92中射出吻合钉112。每个推进器114支撑位于钉仓主体92的刀槽106一侧的两个吻合钉112。
下装配部分122限定了可滑动地接收驱动组件56的片140a-140c的纵向槽122a。安全板123定位在纵向槽122a内的片140a-140c的每一侧上。安全板123中的每一个的远侧端被牢固地固定至下装配部分122。在实施例中，每个安全板123的远侧端123a压配合在于下装配部分122中形成的槽内以将每个安全板123的远侧端轴向地固定至下装配部分122。每个安全板123的近侧端在主体部12的小直径部22内自由滑动。当在工具组件16处于关节式运动位置的状态下驱动组件56被推进以推进动态夹紧构件150通过钉仓主体92从而发射吻合钉112时，安全板123防止驱动组件56的片140a-140c向外弯曲。如上所述，安全板123的近侧端可相对彼此滑动以补偿安全板123和片140a-140c之间的曲率半径的差异。这防止了片140a-140c彼此之间及其与安全板123之间的制约。
参照图6和图8，锁定组件170被支撑在再装载器10的近侧端附近以在再装载器10附接到手术吻合器2的致动装置4以前防止驱动组件56的轴向运动。锁定组件170包括能旋转套筒172和锁紧构件174。能旋转套筒172被装配在主体部12的上下半部分壳体34a、34b的近侧端附近并包括两个向近侧延伸指状物176。能旋转套筒172还限定了凸轮槽178(图8)。锁紧构件174被枢转地支撑在于下半部分壳体34b中限定的切口179(图8)内并包括阻止指状物180和凸轮指状物182。凸轮指状物182定位在能旋转套筒172的凸轮槽178内，且阻止指状物180向下延伸至连接器48的路径(图6)以阻挡近侧驱动构件38的运动。当能旋转套筒172如下文进一步详述的那样旋转时，凸轮指状物182被能旋转套筒172接合以将锁紧构件174从锁定状态枢转至非锁定状态，其中在锁定状态下阻止指状物180阻挡连接器48的运动并因此阻挡近侧驱动构件38的运动，在非锁定状态下阻止指状物180被枢转至与连接器48的运动路径相间隔的位置。
当锁紧套筒172位于下半部分壳体34的近侧端附近时，锁紧套筒172的向近侧延伸指状物176定位为与凸起物140对准。每个向近侧延伸指状物176包括接收在凹部188(图6)中的向内延伸突起186以将套筒172可释放地保持在非致动、可旋转固定位置。当再装载器10附接至致动装置4(图1)时，再装载器10的近侧端插入到致动装置4(图1)的远侧端且被旋转以接合再装载器10和致动装置4的卡口式联接部件。随着致动装置4相对于再装载器10旋转，致动装置4的一部分接合锁紧套筒172的向近侧延伸指状物176以使锁紧套筒172对于再装载器10旋转。当此发生时，凸轮指状物182被能旋转套筒172接合以将锁紧构件174从锁定状态枢转至非锁定状态。如上所述，在锁定状态下，阻止指状物180被定位为阻挡连接器48向远侧运动以阻挡近侧驱动构件38的运动，从而防止可能在再装载器10的运输或装卸期间发生的再装载器10的过早致动。
参照图9-图11，如上简述，致动滑块116分别包括第一凸轮构件166和第二凸轮构件168。每个凸轮构件166、168定位为接合在刀槽106的一侧的一排推进器114。一排推进器114中的每一个推进器114是双发射推进器并支撑在刀槽106的一侧的两个吻合钉112，其中一个在吻合钉的内排，一个在吻合钉112的外排。因此，随着每一个推进器114被滑块116的凸轮构件166，168之一从钉仓主体92向上驱动，两个吻合钉112(每排吻合钉112一个吻合钉)被从钉仓主体92的吻合钉保持槽104驱动进入组织“T”(图9)。在实施例中，凸轮构件166和168的角度可沿凸轮构件166和168的近侧端增大或变陡(图10)。这允许推进器114的最初向上运动更受控制以提供更好的吻合钉变形。通过在刀槽106的每一侧提供两排吻合钉以及单排的双推进器，工具组件16的直径可同样被最小化以被接收通过例如8mm的小直径套管针组件。
在实施例中，每一个吻合钉112具有相同尺寸。替换地，在最靠近刀槽106的向内吻合钉排中的吻合钉112小于在远离刀槽106的向外吻合钉排中吻合钉112。例如，在每一向内排中的吻合钉112的高度可约为2mm而在每一向外排中的吻合钉的高度可约为2.5mm。这种吻合钉布置将在更大的组织厚度范围内提供更好的止血并致使在发射期间对吻合器的钳夹的负荷减小。
图13-图18示出了总体示出为200的本公开的带有小直径内窥镜部的手术吻合器的另一实施例。吻合器200包括手柄组件210、限定纵向轴线的细长体部212以及支撑在细长体部212的远侧端上的工具组件214。在实施例中，手柄组件210、细长体部212和工具组件被牢固地彼此固定并不能彼此卸除。
参照图13，手柄组件212包括：不动手柄或握把216；发射手柄220，其能通过致动行程相对于不动手柄216运动以致动工具组件214；关节式运动旋钮218，其起到使工具组件214相对于细长体212的远侧端关节式运动的作用；收回旋钮222，其使工具组件214返回至非致动位置；以及旋转旋钮224，其便于细长体部212和工具组件214相对于手柄组件212的旋转。美国专利第7,967,178号和‘361专利均公开了适合于与本公开的手术吻合器200一起使用的手柄组件，并且它们的全部内容通过引用合并于此。
还参照图14，如上所述，在实施例中，工具组件214被牢固地固定至细长体212的远侧端并包括砧座组件230(图13)和钉仓组件232。砧座组件230与上述砧座组件24类似并在此不将做进一步详述。钉仓组件232与上述的钉仓组件26的不同之处在于：钉仓组件232包括便于手术吻合器200的重复使用的可拆卸的吻合钉钉仓主体234。更具体地，在手术吻合器200被致动以从钉仓组件232的钉仓主体234中射出吻合钉之后，用过的钉仓主体234可从钉仓组件232的通道240卸下并用装载好的钉仓主体234替换以便于手术吻合器200的重复使用。
还参照图15-图18，钉仓组件232包括钉仓主体234、支撑板235、通道240(图16)、滑块242、多个吻合钉244、第一排246a的双推进器248和第二排246b的双推进器248以及发射锁定组件250。钉仓主体234被接收在支撑板235内且该组件通过搭扣配合连接而附接到通道240。工具组件214以与上述装配组件14类似的方式，通过分别包括上装配部分252a和下装配部分252b的装配组件252被固定至细长体212的远侧端。
如上面关于钉仓主体92所述的，钉仓主体234限定了中央刀槽252和位于中央刀槽252每一侧上的两排吻合钉接收槽254。在一些实施例中，每排吻合钉接收槽254中的槽254相对于中央刀槽252的同侧的另一排中的槽254错开。在推进器248的每一排246a、246b中的每个推进器248与包括中央刀槽252的各侧的每一排中的一个槽254的两个槽254a相关联。滑块242被驱动组件260推动通过钉仓，以与驱动吻合钉抵靠砧座的推进器相互作用。每个推进器均具有在两个推进器板之间的单个凸轮表面。每个推进器板支撑一个吻合钉并错开。滑块在每一侧具有用于接触凸轮表面的单个楔，以及在刀槽中行进的中央构件。
驱动组件260能在细长体212的远侧端内滑动并包括动态夹紧构件262。动态夹紧构件262构造为以上述关于驱动组件56的方式，随着驱动组件260从缩回位置向推进位置运动而移动通过工具组件214以从钉仓组件232中射出吻合钉244。
发射锁定组件250包括枢转锁定件270和偏置构件272。锁定件270被枢转地支撑在下装配部分252b上并定位为接合于驱动组件260的远侧端上形成的止动面274以防止利用用完的钉仓再次发射手术吻合器200。在美国专利公开第2015/0272576号以及美国专利申请序列号第14/812,143号中描述了包括发射锁定组件250的钉仓组件232的操作，这些专利的全部内容通过引用合并于此。
在实施例中，每一个吻合钉244具有相同尺寸。替换地，最靠近刀槽252的向内吻合钉排中的吻合钉244小于远离刀槽252的向外吻合钉排中的吻合钉244。例如，在每一向内排中的吻合钉244的高度可约为2mm而在每一向外排中的吻合钉244的高度可约为2.5mm。这种吻合钉布置将在更大的组织厚度范围内提供更好的止血并致使在发射期间对吻合器的钳夹的负荷减小。
如上所述，手术吻合器200包括内窥镜部，内窥镜部包括细长体部212的远侧部和工具组件214，其构造为具有减小的直径以便于插入通过例如8mm的小直径的套管针。更具体地，通过将锁定组件并入钉仓组件232并使钉仓主体234设置有四排吻合钉和两排双推进器248，手术吻合器200的内窥镜部的直径可被最小化。
本领域技术人员将理解在此具体描述的并在附图中图示出的装置和方法是非限制性的示范实施例。可以设想，与一个示范实施例有关的图示的或描述的元件和特征可以在不背离本公开的范围的情况下与另外的元件和特征相组合。同时，本领域技术人员将知晓基于上述实施例的本公开的进一步的特征和优点。因而，除了如所附权利要求所指出的，本公开不受已特别示出和描述的内容所限制。

Claims (10)

1.一种手术吻合器，包括：
致动装置；
可释放地固定到所述致动装置的再装载器，所述再装载器包括主体部和工具组件，所述主体部包括大直径部和从所述大直径部向远侧延伸的小直径部，所述大直径部限定了第一直径，所述小直径部限定了第二直径，所述工具组件被支撑在所述小直径部的远侧端上，其中所述小直径部被定尺寸为穿过8mm套管针，所述工具组件包括带有滑块的、能拆卸和能替换的吻合钉钉仓，所述滑块在其两侧的每一侧具有单个楔；
驱动组件，其中所述工具组件包括砧座组件和支撑多个吻合钉的钉仓组件，并且所述驱动组件能够运动通过所述主体部和所述工具组件以从所述钉仓组件中射出吻合钉；以及
锁紧组件，所述锁紧组件包括锁紧构件，所述锁紧组件被支撑在所述主体部的所述大直径部内，
其中所述再装载器的所述主体部的所述大直径部包括壳体，并且所述锁紧构件被支撑在所述壳体内且能够从第一位置向第二位置运动，在所述第一位置所述锁紧构件接合所述驱动组件并保持所述驱动组件处于缩回位置，在所述第二位置所述锁紧构件允许所述驱动组件相对于壳体部向远侧运动，并且
其中所述锁紧组件包括安装在所述再装载器的所述大直径部附近的能旋转套筒，所述能旋转套筒与所述锁紧构件接合以使得所述能旋转套筒的对于所述再装载器的所述大直径部的旋转引起所述锁紧构件从所述第一位置向所述第二位置运动。
2.根据权利要求1所述的手术吻合器，进一步包括细长体，所述细长体从所述致动装置向远侧延伸，所述再装载器被支撑在所述细长体的远侧端上。
3.根据权利要求1所述的手术吻合器，其中所述能旋转套筒限定有凸轮槽且所述锁紧构件包括被接收在所述凸轮槽中的凸轮指状物，其中所述能旋转套筒的对于所述再装载器的所述大直径部的旋转使所述能旋转套筒接合所述凸轮指状物以使所述锁紧构件从所述第一位置向所述第二位置运动。
4.根据权利要求3所述的手术吻合器，其中所述锁紧构件包括被定位为阻挡所述驱动组件从所述缩回位置向远侧运动的阻止指状物。
5.根据权利要求4所述的手术吻合器，其中所述驱动组件包括近侧驱动构件，并且所述致动装置包括控制杆，所述近侧驱动构件支撑位于所述主体部的所述大直径部内的连接器，所述连接器被构造为可释放地接合所述控制杆以将所述控制杆的运动转化为所述近侧驱动构件的运动。
6.根据权利要求1所述的手术吻合器，其中所述驱动组件包括动态夹紧构件，其被定位为移动通过所述工具组件以从所述钉仓组件中射出多个吻合钉。
7.根据权利要求6所述的手术吻合器，其中所述钉仓组件包括钉仓主体，所述钉仓主体限定有刀槽和在所述刀槽的每一侧的两排吻合钉。
8.根据权利要求7所述的手术吻合器，其中所述钉仓主体在所述刀槽的每一侧支撑一排推进器。
9.根据权利要求1所述的手术吻合器，进一步包括被支撑在所述砧座组件的远侧端上的解剖尖端。
10.根据权利要求1所述的手术吻合器，进一步包括被支撑在所述砧座组件上的支撑件材料。
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US20200015822A1 (en) 2020-01-16
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