CN1102845C - 电外科器械 - Google Patents

电外科器械 Download PDF

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CN1102845C
CN1102845C CN95113177A CN95113177A CN1102845C CN 1102845 C CN1102845 C CN 1102845C CN 95113177 A CN95113177 A CN 95113177A CN 95113177 A CN95113177 A CN 95113177A CN 1102845 C CN1102845 C CN 1102845C
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N·M·戈布尔
C·C·O·戈布尔
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Abstract

一种电外科切割装置包括一个器械主体(10)，第一和第二切割刀片(12)和(14)，它们至少一个绕枢轴装在主体上，以便实现相对于另一个刀片的剪切作用。与主体(10)相连的供电导体(24)向第一和第二刀片(12)和(14)供给电外科电压。第一刀片(12)是一个由导电的外电极(12A)，内导电层(12C)和夹在两者之间的绝缘层(12B)组成的复合的刀片。供电导体(24)分别连接到外电极(12A)和内层(12C)上。

Description

电外科器械
发明领域
本发明涉及装有一对刀片以便能实现剪切作用的电外科切割装置，由此，当施加电外科电压时，该装置能同时起到脱水和剪切活组织的作用。
背景技术
众所周知，为了实现用具有一对装在细长转轴端部的刀片的剪子进行外科切割，每把刀片可以围绕横过响应于在刀片和转轴另一端的手柄之间延伸的控制杆的运动的转轴转动，两把刀片彼此电绝缘，且在相对的表面上具有陶瓷涂覆层，因此，它们可以连接到双极电外科的电源上，而且不会短路。夹在刀片之间的组织受到切割刀刃交会处的远端上的电外科电流的通过，以便当刀片闭合在一起时在机械切断之前能使组织脱水。
发明内容
按照本发明，在于提供一种电外科切割装置，它包括一个器械主体，第一和第二切割刀片，所说的刀片至少有一个旋转地装在所说的主体上，以便与另一把刀片一起实现剪切作用，以及一个与主体相连的供电导体，用于把双极电外科电压供给第一和第二刀片，其中第一刀片是一个包括一个导电的外电极，一个内导电层和夹在外电极和内导电层之间的一个绝缘层的复合刀片，供电导体分别连接到外电极和导电内层上。优选地，供电导体之一是直接连接到内层上。
为方便起见，供电导体之一连接到第二刀片上，并通过第二刀片和内层间的电接触电连接到复合的第一刀片的内层。优选地，第二刀片具有一个与复合的第一刀片的内层电接触的导电体，而所说的一个供电导体连接到导电的主体上，由此，导电的主体串联地电连接在所说的一个供电导体和内层之间。
每个刀片具有一个切削刃，所说的切削刃是如此取向，即两把刀片实现递增的剪切作用，每个切削刃是用金属材料制成。的确，第二刀片优选的是具有全金属主体，且在主体上有切削刃的简单的金属刀片。在一个优选实施例中，两把刀片绕枢轴装在器械主体上。
如果刀片考虑到具有两个剪切表面，所说的表面在切割作用过程中以面对面的相互啮合关系渐进地彼此叠合，且两个剪切表面是在各个切片的导电件上，复合的第一刀片的内层和至少第二刀片支承其剪切表面的部份上是处于一个电位上，复合的第一刀片的外电极是处于不同的电位上，由此产生了两个电场：复合的第一刀片的外电极和内导电层之间的(a)及复合的第一刀片的外电极和第二刀片之间的(b)，这是由于剪切表面之间的电接触所致。
每个刀片优选地包括一个细长件，它具有一个外表面，一个内剪切表面，和一个沿刀片延伸的并在剪切表面和沿剪切表面一侧的外表面之间所限定边界的切削刃，刀片是以这样的方式装在器械主体上，即，它们各自的切削刃能实现渐进的剪切作用，这是由于当两把刀片以面对面的关系使剪切表面成为移动到一个具有剪切表面的闭合结构时，复合的第一刀片的外表面限定了一个靠近其切削刃的沿刀片延伸的切削面，每个内导电层、绝缘层和外电极是沿切削面暴露的，并且在内导电层上至少靠近切削刃处形成剪切表面。
优选地，第二刀片具有一个导电的主体，还具有一个靠近其切削刃的沿刀片延伸的切削面，导电的主体至少在切削刃和切削面区域之上是暴露的。刀片的切削面优选地是至少部分地垂直于剪切表面，由此，在切削刃相交的远端上，切削面彼此相对，即使按偏置的关系，以便使它们与刀片之间横向延伸的一块组织电接触，因此，在使用该装置时，位于刀片和切削刃相交的远端之间的组织须经受流经组织的电外科电流，此电流一方面是复合的刀片的外电极与该刀片的内层之间的，另一方面是复合刀片外电极和第二刀片之间的。这就在切削刃的交会处先于机械分离之前产生脱水作用，此时刀片接近闭合状态。
在某些情况下，特别是当组织面的取向使机械分离成为困难时，本发明的优选实施例是可以用于纯电外科切割的，亦即没有机械分割。为达到这个目的，优选实施的复合的第一刀片的外电极、绝缘层和内导电层是每个沿电外科切削表面暴露的，所说的切割表面构成从切削刃靠近该刀片的剪切表面相对一侧沿该刀片延伸的复合的第一刀片的部分外表面。第二刀片通常做得比复合的第一刀片要窄，且是这样安装的，即在刀片的闭合状态时，第二刀片的切削刃是从复合的第一刀片的电外科切割表面沿复合的第一刀片的剪切表面延伸。因此，从复合的第一刀片的切削刃起在其相对一侧上，外电极、绝缘层和内导电层存在一个带状表面，沿该表面所有的这三层并排地暴露，由此，当片刀处于其闭合位置时，当电外科电压通过绝缘层施加时，复合的第一刀片的这一侧可以按刀的方式使用。
本发明还提供了电外科切割装置，它包括一个电外科发生器和一个如上所述的双极的电外科切割装置，发生器具有一个具正负极的不平衡输出，其中供电的导电体的连接是如此安排的，即为了组织脱水和机械切割，正极是接到复合的第一刀片的外电板上。同样地，为了电外科切割，正极优选地接到第二刀片或复合的第一刀片的内层上。
切割装置还可以有一个控制开关，以便供电导体连接可以按照装置是用于组织脱水和机械切割同时进行还是用于电外科切割进行转换。
附图说明
现在借助例子，参考附图对本发明进行描述，其中，
图1是按照本发明构成的包括部份双极电外科切割器械的电外科装置图，图中示出了一对绕枢轴安装在细长器械主体端部的切削刀片，图中还以方框图形式示出了装置的其它部份：
图2是按图1的A-A剖面线通过刀片的剖面图；
图3A和3B是在使用时的刀片的剖面图，表示在刀片之间的一块活组织中的电外科电流分布；
图3C是与相关的电外科发生器和开关在一起的刀片剖面图；
图4是按照本发明构成的第二电外科器械的刀片侧视图；
图5是图4的刀片的端视图；
图6是沿图4的X-X剖面线的剖视图。
具体实施方式
参照附图的图1和图2，按照本发明构成的第一个电外科切割器械，试图作为腹腔镜使用，它具有一个在其近端按传统方式装到手柄11(以方框图形式表示)上的细长管状主体10，主体10的远端是两个切削刀片12和14，每一个刀片绕枢轴安置，以便围绕横过主体10的轴取向的轴16转动。每个刀片12和14具有一个在轴16之外近端延伸的指形部份18，指形部份的支承销钉18A装在主体10内的往返致动器22对侧上的槽20内(在图1中只示出了一个)。控制杆22A把往返致动器22连接到手柄11内的触发机构上(未示出)，由此，当触发机构工作时，控制器在主体10内纵向移动，使刀片12和14能围绕横向轴16转动。供电导体24通过手柄11和与它连接的相应刀片12和14之间的管状主体10。
手柄11连接到电外科发生器26上。
正如从图2所看到的，刀片12是由金属的外电极12A，绝缘层12B和内导电层12C组成的复合刀片。另一个刀片14是具有金属体的简单刀片，且在该实施例中，按照剪切表面的宽度它比复合刀片12窄，复合刀片12的内导电层12C构成该刀片的剪切表面，该剪切表面在一侧上由切削刃12D为终结，复合刀片12的外表面12E是从切削刃12D环绕地延伸到由内层12C形成的剪切表面的另一侧，靠在切削刃12D上的外表面12E的部份12F可以被看作切削面，外电极12A至少在该切削面12F处暴露。绝缘层12B和内导电层12C也可以沿面12F暴露。
简单的刀片14也具有一个剪切表面，该表面当刀片12和14处于如图1和图2所示的闭合形状时面对复合刀片12的剪切表面，刀片14还具有一个切削面14F，该切削面当两把刀片处于开启形状时面对复合刀片12的切削面12F，即使它处于偏置关系时，简单刀片14的切削面14F在切削刃14D处终结，所说的切削刃14D当刀片处于闭合形状时覆盖在由复合刀片12的内层12C形成的剪切表面上。
电源导体24分别连接到复合刀片12的外电极12A和简单刀片14上，因此，当电外科电源，例如，发生器26，在导体24的手柄端处施加时，电外科电压一方面是在外电极12A和层12C之间产生，另一方面是在外电极12A和内简单刀片14之间产生。
这种连接方法的效果示于图3A和图3B中。参照这些附图，图中示出了刀片12和14在开启时的状态并且在切削刃12D和14D交叉的刀片远端之间有一块在横向上被夹住的活组织，通过组织28有两条电路30和32，第一条电路30在复合刀片12的外电极12A和内导电层12C之间，如图3A中所示，应该注意到内导电层12C与简单的刀片14处于同样的电位，这是由于两个刀片12和14的剪切表面和/或切削刃12D和14D之间的电接触靠近切削刃的交会点。第二条电路32(如图3B所示)是在复合刀片12的外电极12A和简单电极14的切削刃14D之间延伸。实际上，两条电路30和32共同在沿组织28的一条线产生脱水作用，所说的线相应于当刀片12和14从它们的张开位置到闭合位置时所产生的机械割开线，由此，防止沿切割线出血。
由于在复合刀片12的内导电层12C和简单刀片14之间没有电外科电流流过，所以在剪切表面不需要绝缘材料。
电路30提供了一个比主电路32小的脱水区域，如在图3B中所示，整个效果是通过两个电路的电流之和。两个电路30和32在刀片12和14的方向上被拉长了，还应该注意，当刀片12和14闭合时，组织28受到挤压，组织脱水的量则增加了。
正如从图3A和3B中理解到的，当观察这些附图时以顺时针方向转动器械将增加组织28和两个刀片12和14之间的接触，由此减少了组织接触阻抗，外电极12A和简单刀片14两者都具有超过相应的组织接触部分的导电外表面。
还应该理解，因为在简单刀片14的剪切表面上没有绝缘层，这样当剪子处于开放状态时可以用通过复合刀片12的外表面12E、12F接通的双极电外科电路连接到组织28上，因此，较大容积的组织28包括在电流流迹内，以便在机械切割之前引入大的脱水区域。
再参考图2，可以看出外电极12A，绝缘层12B和内导电层12C全部沿形成复合刀片12的部分外表面12E的表面条12G暴露，所说的表面条对着切削面12F，该表面条12G可以作为电外科刀使用。应该注意的是简单刀片14比复合刀片12窄，且当刀片处于完全关闭状态时，简单刀片14的切削面14F沿与表面条12G隔开的复合刀片12的剪切表面移动，以便清洁电外科切削刃。
使用电外科切削刃12G的电外科切削效果可以通过增加靠近切削刃12D的组织内的电流密度而提高。在具有非平衡输出的电外科发生器26的情况下，这可以通过把发生器的“主动”或“馈送”输出端26A连接到简单刀片14(或直接连到复合刀片12的内层12C)上，以及把“被动”或“返回”输出端26B接到复合刀片12的外电极12A上来实现。这样连接的效果如下：由于发生器26的负输出端26B至少对于交变电流是耦合到发生器26的内接地导轨26C上，而主动端26A连接到振荡器或放大器输出端26D上，通过病人接地的泄漏电流是来自主动端26A的远大于来自被动端26B的，由被动端26B接地的电容比较大。其结果是不是所有的来自主动端26A的电流施加到病人组织上而是通过被动端26B返回。某些是电容地耦合接地。通过把主动端26A有效地接到内层12C上，在组织28和电外科切削面12G之间的交接面上的峰值电流密度是最大的，因为在切削面处的内层12C的表面面积比外电极12A的表面面积小。
可是对照电外科切割的要求，用于脱水的优选电流分布在穿过组织和复合刀片12之间的交叉面应尽可能的接近于均匀分布。因此，为了将脱水和机械切割(如图3A和3B所示)结合起来，优选的是把正极26A接到复合刀片12的外电极12A上，而把负极26B接到简单刀片14(和内层12C)上。因此，按照是需要脱水还是需要切割，提供了一个用于把电源导体24分别反接到接点26A和26B上的开关34。图3C详细地示出了开关34，它具有两对接触点34A和34B以及一个双臂接触点34C，所说的双臂接触点34C可以从第一操作位置(图3C所示)移动到第二操作位置，在第一操作位置正极26A接到外电极12A上，负极26B接到简单刀片14上，这时器械用于脱水；而在第二操作位置正极26A接到简单刀片14上，负极26B接到外电极12A上，这时器械用于电外科切割。
如图1所示，可变换位置的开关34装在手柄11上，真正的开关接触点34A，34B和34C优选地是装在发生器26内，且借助控制线36控制来自开关34的延迟，此延迟操纵着接触点。手柄11还包括一个用于控制电外科能量施加到导电体24上的开关40。另一方面，用于这种功能的实用开关也可以通过开关40和发生器26之间的控制线42来控制延迟而实现。
接下去参照图4至图6，按照本发明构成的第二种电外科器械具有弯曲的切割刀片12和14，所说的刀片是围绕一个弯曲的轴弯曲，所说的轴是以装置的纵轴隔开且横过装置的纵轴。复合刀片12，如第一实施例中那样具有一个外电极12A，一个由环氧树脂粘合剂制造的内绝缘层12B和一个由硬的耐磨损金属制成的内导电层12C。另一把刀片14如图所示也是弯曲的，以便与复合刀片12的弯曲度相匹配。如前所述。这是一种简单的金属部分。两个刀片12和14可以围绕横向框轴16转动，并具有用于连接致动器1(未示出，但与图1中的往返致动器22相似)从轴16的近端延伸的指形部分18。图4示出了把电外科电源导体24装到刀片12和14的指形部分18上的情况。特别是参照图6，可以看出复合刀片12有一个用于增加强度的外肋12H。

Claims (15)

1.一种电外科切割装置，包括一个器械主体，第一和第二切割刀片，它们至少一个绕枢轴装在主体上，以便实现相对于另一个刀片的剪切作用，以及用于把电外科电压供给第一和第二刀片的与主体相连的供电导体，其特征在于：第一刀片是一个包括导电的外电极、一个内导电层和一个夹在外电极和内导电层之间的绝缘层的复合刀片，供电导体分别连接到外电极和内层上，每个刀片有一个其取向可使刀片实现渐进的剪切作用的切削刃，第一刀片的内导电层、绝缘层和外电极沿切削表面暴露，该切削表面沿着靠近刀片切削刃的刀片延伸，由此在内导电层上至少靠近切削刃的地方形成了一个剪切表面；第二刀片有一个导电主体和一个切削表面，该切削表面沿着靠近刀片切削刃的刀片延伸，第二刀片的导电主体至少在切削刃上和沿着第二刀片的切削表面是暴露的。
2.按照权利要求1所述的装置，其中供电导体之一是直接连接到内层上。
3.按照权利要求1所述的装置，其中供电导体之一是连接到第二刀片上并通过第二刀片和内层之间的电接触电连接到复合的第一刀片的内层上。
4.按照权利要求3所述的装置，其中第二刀片的导电主体与复合的第一刀片的内层电接触，并且其中所述的一个供电导体被连接到导电主体上，由此导电主体在所述的供电导体和内层之间串联电连接。
5.按照权利要求1所述的装置，其中每个切削刃是由金属材料制成。
6.按照权利要求1所述的装置，其中第二刀片具有一个全金属体，它的切削刃是在所述主体上形成。
7.按照权利要求1所述的装置，其中两个刀片绕枢轴装在器械主体上。
8.按照权利要求1所述的装置，其中每个刀片包括一个具有一个外表面、一个限定剪切表面的内表面、和一个沿着刀片延伸并在剪切表面和沿剪切表面一侧的外表面之间限定了边界的切削刃的长形部件，其中所述刀片如此装在器械主体上，即当刀片以其剪切表面面对面的关系移动到闭合状态时，它们各自的切削刃实现渐进的剪切作用，其中复合的第一刀片的外表面限定了所述刀片的切削表面。
9.按照权利要求1所述的装置，其中第二刀片的导电主体至少暴露在所述刀片的剪切表面的主要部分上。
10.按照权利要求1所述的装置，其中复合的第一刀片的外电极、绝缘层和内导电层的每一个沿电外科切削表面暴露，该切削表面构成靠近该刀片的剪切表面沿该刀片延伸的复合第一刀片的部分外表面。
11.按照权利要求10所述的装置，其中电外科切削表面从切削刃沿着靠近该刀片剪切表面对侧的复合第一刀片延伸，并且其中刀片具有如此形状并如此安装，即在它们的闭合状态，第二刀片的切削刃沿复合第一刀片的剪切表面延伸，并与复合的第一刀片电外科切削表面隔开。
12.按照权利要求1所述的装置，还包括一个用于转换供电导体连接的开关。
13.一种电外科切割设备，包括一个电外科发生器和一个双电极电外科切割装置，该双电极电外科切割装置包括一个器械主体，第一和第二切割刀片，它们至少一个绕枢轴装在主体上，以便实现相对于另一个刀片的剪切作用，以及用于把电外科电压供给第一和第二刀片的与主体相连的供电导体，其特征在于：第一刀片是一个包括导电的外电极、一个内层和一个夹在外电极和内层之间的绝缘层的复合刀片，供电导体分别连接到外电极和内层上，每个刀片有一个其取向可使刀片实现渐进的剪切作用的切削刃，第一刀片的内导电层、绝缘层和外电极沿切削表面暴露，该切削表面沿着靠近刀片切削刃的刀片延伸，由此在内导电层上至少靠近切削刃的地方形成了一个剪切表面；第二刀片有一个导电主体和一个切削表面，该切削表面沿着靠近刀片切削刃的刀片延伸，第二刀片的导电主体至少在切削刃上和沿着第二刀片的切削表面是暴露的；所述发生器具有一个有正极和负极的不平衡输出，其中供电导体的连接是如此安置的，即用于为组织脱水和机械切割时，正极是连接到复合第一刀片的外电极上。
14.一种电外科设备，包括一个电外科发生器和一个双电极电外科切割装置，该双电极电外科切割装置包括一个器械主体，第一和第二切割刀片，它们至少一个绕枢轴装在主体上，以便实现相对于另一个刀片的剪切作用，以及用于把电外科电压供给第一和第二刀片的与主体相连的供电导体，其特征在于：第一刀片是一个包括导电的外电极、一个内导电层和一个夹在外电极和内层之间的绝缘层的复合刀片，供电导体分别连接到外电极和内层上，每个刀片有一个其取向可使刀片实现渐进的剪切作用的切削刃，第一刀片的内导电层、绝缘层和外电极沿切削表面暴露，该切削表面沿着靠近刀片切削刃的刀片延伸，由此在内导电层上至少靠近切削刃的地方形成了一个剪切表面；第二刀片有一个导电主体和一个切削表面，该切削表面沿着靠近刀片切削刃的刀片延伸，第二刀片的导电主体至少在切削刃上和沿着第二刀片的切削表面是暴露的；所述发生器具有一个有正极和负极的不平衡输出，其中供电导体的连接是如此安置的，即用于电外科切割时，负极是连接到复合第一刀片的外电极上。
15.按照权利要求14所述的设备，其中切割装置包括一个用于转换发生器输出端与刀片连接的开关。
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KR960020947A (ko) 1996-07-18
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US5860975A (en) 1999-01-19
FI114609B (fi) 2004-11-30
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TW286272B (zh) 1996-09-21
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JPH08252263A (ja) 1996-10-01

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