CN1720872A - 组织缝合方法和组织缝合器 - Google Patents
组织缝合方法和组织缝合器 Download PDFInfo
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Abstract
用于传送位置信息给缝合针接收部分的位置信息传送部件设置在具有该缝合针接收部分(基部)的组织缝合器中。从而,操作者能容易地掌握缝合针接收部分在组织中的位置并能迅速执行缝合。一般地,组织缝合器的构成包括:具有内窥镜插入管路的缝合部分,设有布置在插入部分的远端侧上的缝合针射出部分的缝合部分,和与插入部分分开设置的缝合针接收部件(基部),该部件在通过组织与缝合部分相对的状态下,由通过插入部分引入的处置工具夹持固定,用于使从缝合部分的缝合针射出部分射出并穿透组织的缝合用缝合针部件的远端部分弯折。
Description
相关申请的交叉引用
本申请基于并要求2004年7月14日提交的在先日本专利申请No.2004-207740的优先权,本文以参考的方式结合其整个内容。
技术领域
本发明涉及组织缝合方法和组织缝合器。例如在食道和胃等管腔脏器在外科手术等操作过程中承受吻合或固定处理时,使用组织缝合器。
背景技术
组织缝合器在现有技术中是公知的。组织缝合器在切除例如大肠或小肠的管腔脏器的病变部分之前或之后用于吻合正常管腔脏器的端部,或用于吻合所述胃和小肠的侧部。通过多个环状布置的作为缝合部件的缝合针来缝合组织并同时切除呈环状被缝合的组织的大致中心部分,这种组织缝合器能大大地缩短手术时间。
同时,这种组织缝合器在插入(引入)到管腔脏器内的插入部分的远端设置有缝合部分,该缝合部分具有多个缝合针,且缝合部分的远端部分与作为组织固定部分的基部(anvil)可安装地且可拆卸地成为一体。该基部通过与从缝合部分突出的缝合针接触,使缝合针的足部折叠弯曲,从而缝合组织。另外,在组织缝合器的插入部分的近侧上设置有控制部。
近年来,提出了一种待插入到管腔脏器内的插入部分,该插入部分考虑到插入到管腔脏器的深部的能力而形成为具有柔性,或者通过在其远端布置观察光学系统来改进插入性(例如,参见JP-A-2003-111763,U.S.P.No.5,411,508)。
此外,当利用具有改进插入性的插入部分的组织缝合器来使管腔脏器吻合时,插入部分和基部通过口或肛门插入到管腔脏器内。而且,通过确认插入部分的远端位置和与该插入部分结合使用的基部的位置并控制它们中至少一个的运动,可以在管腔脏器的体腔中的目的位置处使管腔脏器吻合。
因而,除了在硬性镜和钳子的辅助下进行吻合,近年来还提出了一种组织缝合器,其通过在吻合部分和基部上相对地布置磁铁以通过磁力使它们相互靠近,从而改善操作性(例如,参见U.S.P.No.5,411,507)。
但是,虽然在JP-A-2003-111763和U.S.P.No.5,411,508的组织缝合器中公开了观察光学系统,但是该装置本身设置在管腔脏器中,且因此为了在吸引体腔中布置在相互远离的位置处的脏器的同时执行吻合,需要经腹部插入(引入)的硬性镜和钳子的辅助。此外,即使在经腹部的方法的前提下,组织缝合器的远端位置和设置在管腔脏器中的基部的位置也需要通过硬性镜来确定并通过夹持钳子而被夹持引导,且因此存在处理操作繁琐的缺点。
此外,U.S.P.No.5,411,507的组织缝合系统在待吻合的组织没有被设置成相互靠近时并不起作用,且因此需要经腹部插入的硬性镜和夹持钳子的辅助,这同样是一个缺点。
本发明是鉴于上述情况而做出的,且因此本发明的目的是提供处理操作性改善的组织缝合器。
发明内容
在组织缝合器的缝合针接收部分(基部)中,本发明的特征在于提供用于在其中传送位置信息的位置信息传送部件。
组织缝合器的构成包括:插入部分,其具有内窥镜插入管路;缝合部分,其具有布置在所述插入部分的远端侧上的缝合针射出部分;和缝合针接收部件(基部),其设置成与所述插入部分分开。所述缝合针接收部件在与所述缝合部分相对的状态下,由通过插入部分被引入的处置工具夹持。所述缝合针接收部件能使穿过组织的缝合部件的远端部分折叠(弯曲),其中该缝合部件已经从缝合部分的缝合针射出部分射出。
根据上述构成,在缝合针接收部分处,通过检测从位置信息传送部件发出的位置信息,操作者可以知道缝合针接收部件在组织中的位置。因此,操作者可通过基于该位置信息操作插入到所述插入部分中的处置工具,从而夹持所述缝合针接收部分。因此,能方便且容易地完成缝合的准备工作,而不用凭直觉,并能实现快速的缝合处理。
附图说明
根据下面的说明、所附权利要求和附图可以更好地理解本发明装置和方法的这些和其它特征、方面和优点,其中:
图1是表示根据本发明第一实施例的组织缝合器的外观的构成图;
图2是表示图1的基部和缝合部分的剖视图;
图3是表示图1的基部的轴部件的剖视图;
图4是表示图1的一部分基部夹持件的剖视图;
图5是表示图1的基部和缝合部分插入到组织中的状态的视图;
图6是表示从图5所示的状态由基部夹持件通过组织来夹持基部的状态的视图;
图7是表示从图6所示的状态由基部夹持件通过组织来夹持基部的状态的视图;
图8是表示从图7所示的状态对组织进行缝合和吻合处理的状态的视图;
图9是表示从完成图8所示的组织缝合和吻合的状态使缝合的部分分离的状态的视图;
图10是表示第一实施例所采用的基部夹持部分的另一示例的视图;
图11是表示第一实施例所采用的基部夹持部分的另一示例的视图;
图12是表示夹持固定图11的组织的状态的视图;
图13是表示第一实施例所采用的基部夹持部分的另一示例的视图;
图14是表示图13的夹持和固定状态的视图;
图15是表示根据本发明第二实施例的组织缝合器的主要部分的剖视图;
图16是表示缝合图15的组织的状态的视图;
图17是表示在用图15的缝合部分来缝合组织之前的状态的视图;
图18是表示缝合图17的组织的状态的视图;
图19是表示根据本发明第三实施例的组织缝合器的一部分基部的剖视图;
图20是表示图19的基部的基部臂展开状态的视图;
图21是表示通过在图19的基部的缝合部分侧上的基部夹持件来夹持固定组织的初始状态的视图;
图22是表示通过基部夹持件来夹持图21的基部的状态的视图;
图23是表示通过基部夹持件来夹持固定图21的基部的状态的视图;
图24是表示从图23的状态对组织进行缝合和吻合处理的状态的视图;
图25是表示根据本发明第三实施例的组织缝合器中所使用的基部的另一示例的视图;
图26是表示根据本发明的组织缝合器的参考示例的视图;
图27是表示图26的组织缝合器在缝合组织之前的状态的视图;
图28是表示图27的组织的缝合完成状态的视图;
图29是表示根据本发明的组织缝合器的另一参考示例的视图;
图30是表示限制图29的缝合部件的状态的视图;以及
图31是用于说明缝合图29的组织的过程的视图。
具体实施方式
下面参照附图来说明本发明的实施例。
图1表示根据本发明第一实施例的组织缝合器。该组织缝合器包括基部12,该基部作为缝合针接收部件且与缝合器主体2分开设置。
缝合器主体2具有位于插入部分3的远端侧上的缝合部分4和位于插入部分3的近侧上的近侧控制部5。插入部分3在其大致轴向部分上(参照图2)形成有从缝合部分4到手持控制部5的内窥镜插入管路6,且该内窥镜插入管路6插入有内窥镜7。内窥镜7的处置工具插入管路8插入有处置工具,例如基部夹持件11,且基部12通过基部夹持部分9被可拆卸地夹持在基部夹持件11的远端处。基部夹持件11在近侧上设有近侧控制部10,且该近侧控制部10可操作地位于插入部分3的近侧上。
缝合部分4插入有大致为中空的缝合针容器41,且缝合针容器41的远端面设有成环状排列为两排形式的多个缝合针容纳孔20(参照图2)。缝合针容纳孔20安装有缝合针21,缝合针分别作为大致为马蹄状的缝合用的缝合部件。这里,多个缝合针容纳孔20排列成两排以环状的形式轮替地设置在内周侧和外周侧上。
另外,缝合针容器41在缝合针容纳孔20的内周侧上设有刀具部件插入孔22,其成环状且与缝合针容纳孔20平行。此外,大致为圆柱形状的移动部件23沿内窥镜插入管路6的轴线可移动地插入到缝合针容器41中。在移动部件23的近侧的一端上设有凹螺纹部分24,且该螺纹部分24与螺钉部件27螺纹联接。螺钉部件27通过电缆28与后面将提及的电动机单元15(参照图1)连接。当电动机单元15被驱动时,其转动力通过电缆28被传送以调节相对于移动部件23的螺纹联接状态,从而使移动部件23沿轴向移动。
移动部件23的另一端设有多个缝合针挤压部件25,每个缝合针挤压部件都大致为板状且处于与缝合针容纳孔20相对应的位置处,所述缝合针挤压部件的宽度和厚度使其可插入到相应的缝合针容纳孔20中。当移动部件23朝向近侧向后最大程度地移动时,缝合针挤压部件25的远端位于缝合针容纳孔20的近侧端。此外,在移动部件23朝向远端侧最大程度地向前移动的状态中,移动部件23推动以使缝合针挤压部件25沿相同的方向移动,从而与缝合针21接触,以从缝合针容纳孔20的远端面挤出缝合针21。
此外,在缝合针挤压部件25的内侧中设有刀具部件26,其为整体包围内窥镜插入管路6的圆柱形状。刀具部件26的刃尖在移动部件23位于最近侧位置处时被收纳在缝合部分4的缝合针容纳部件41中,且在移动部件23位于最远侧位置时从缝合部分4的远端面突出。
基部12包括基部主体42和轴部件16,且轴部件16形成为具有可插入到内窥镜插入管路6中的外径。轴部件16设置有从基部主体42延伸的轴30(参照图3),且轴30的远端侧形成有大致为球形的远端夹持部分32。此外,远端夹持部分32的近端侧(后端侧)在轴16的整个周边上形成有装配槽33,且基部夹持部分9可拆卸地夹持在装配槽33处。
此外,轴30从装配槽33的后部到基部主体42被轴盖部件31覆盖。轴盖部件31在装配槽33附近设有透明部分35,且轴30在透明部分35内侧设有例如LED等的发光部件34,该部件构成位置信息传送部件。发光部件34通过电缆36电连接到设置在基部主体42中的电源部件(未示出),并由该电源部件(未示出)供电而发光。
基部主体42具有多个凹入部分17,用于使大致呈环状以两排的方式设置在与缝合部分4的缝合针容纳孔20相对的位置处的缝合针足部折叠(弯曲)。此外,大致为环状的刀具部件接收狭缝18设置在与缝合部分4的刀具部件26相对的位置处。此外,基部主体42具有组织接收部分19,用于接收围绕轴部件16的近端待被切除的组织。基部主体42设有导线插入孔39a(通孔),用于连接其远端侧和组织接收部分19(参照图2)。
此外,近侧控制部5通过防折叠部件13延伸有电缆管14,该电缆管14的端部电连接到电动机单元15。电动机(未示出)容纳在电动机单元15中,且电动机的转动力被传送给电缆28。电缆28设置在连接电缆管14和缝合部分4的电缆管路29内,并连接到螺钉部件27用于传送所述转动力。
基部夹持件11设有基部夹持部分9,从而能在其远端夹持和释放基部12。如图4所示,基部夹持部分9设有一对大致为中空形状的夹持臂38,它们以位于插入部分3的远端处的轴37为中心可打开和可闭合地枢转,且夹持臂38的远端部分设有在夹持臂38的闭合状态中形成开口的夹持槽39。当夹持臂38闭合时,夹持槽39与基部12的装配槽33装配。基部夹持部分9的该对夹持臂38通过连杆机构(未示出)和操作线(未示出)与设置在插入部分3的近侧上的近侧控制部10连接。夹持臂38通过近侧控制部10的打开-闭合操作,经由所述操作线和连杆机构而被操作打开和闭合。
在上述结构中,当组织(例如,大肠)被部分切除以缝合时,操作者先经肛门插入导线45到达大肠46的深部,如图5所示。另外,操作者从导线45的肛门侧端插入基部12,使其在导线45的引导下经过导线插入孔39a到达超过病变部分73的位置。接着,操作者在内窥镜7插入在内窥镜插入管路中的情况下,将缝合器主体2的插入部分经肛门插入到大肠46中。作为位置检测装置的内窥镜在大肠46中到达病变部分73附近并停止在其肛门侧。
在这种情况下,操作者通过经腹部插入的硬性镜47确认基部12和缝合器主体2的插入部分3。在这种情况下,由于轴30中的发光部件34和插入到插入部分3中的内窥镜7发出光,因此通过观察透过大肠46的肠壁的光可以知道基部12的位置。因此,所述光构成位置信息。
此外,当操作者通过夹持钳子74而夹持大肠46的病变部分73附近且将夹持部分移动到一侧时,该夹持钳子为经腹部插入到体腔中的引导部件,操作者通过另一夹持钳子48将基部12拖到插入部分3的缝合部分4附近。
例如,当大肠形成环形时,大肠46的侧面和其它侧面相互接近,且基部12和插入部分3的缝合部分4变得相互靠近。操作者在使基部12和缝合部分4相互靠近的状态下,通过减少硬性镜47发出的光量,通过内窥镜7检测从基部12的发光部件34发出的光。当轴30被基部夹持件11夹持时,通过利用光作为引导的肠壁,基部12的远端被夹持部分32容纳在夹持臂38的中空部分中,且夹持臂38的夹持槽39与装配槽33装配在一起。从而,远端被夹持部分32被基部夹持件11牢固地夹持固定(参见图6和图7)。
接着,操作者在将基部12与大肠46夹持在一起的状态下,通过基部12和插入部分3的缝合部分4将内窥镜7和基部夹持件11引入到内窥镜插入管路6中,并将两层大肠壁插设在它们之间。在这种情况下,通过驱动电动机单元15而使电缆28旋转。然后,电缆28的转动力传递给螺钉部件27,螺钉部件27被驱动而转动,从而移动部件23朝所述远端侧方向线性移动。
在这种情况下,移动部件23推动缝合针挤压部件25,使该缝合针挤压部件随着其移动而朝向远侧方向移动,并使缝合针21从缝合针容纳孔20中被挤压出。
然后,缝合针21的远端部分穿透两层大肠壁而与基部主体42的凹入部分17压力接触,且缝合针的足部沿着凹入部分17的形状折叠到(弯曲到)内侧以缝合所述大肠壁。此外,与缝合针挤压部件25连续的刀具部件26通过移动部件23从缝合部分4突出并切割大肠壁以形成吻合开口部49。在这种情况下,刃尖被收纳在刀具部件接收狭缝18中。由刀具部件26切除的组织被捕获在组织接收部分19中。
在以这种方式完成缝合和切除大肠壁的阶段,基部夹持件11暂时向前移动以在基部12和缝合部分4之间形成间隙,这样被缝合针21缝合的大肠46就被释放,之后,拔出插入部分(参照图8)。
根据大致形成为环形的大肠46,在环部中肠腔侧面结合有病变部分73而被吻合。操作者通过经腹部插入肠腔中的组织缝合切除器43切除和缝合所述环部的每个根部(参照图9)。
此外,尽管在上面的说明中,对切除大肠部分的过程进行了说明,但是操作并不受此限制,在缝合其它组织的处置过程中也能同样地操作。也就是说,操作者将基部12插入到第一组织中并将插入部分3插入到第二组织中,其中基部12构成了具有发光部件34的缝合针接收部件,而该发光部件构成位置信息传送部件。根据该实施例,插入部分3包括结合有基部12的缝合部分4,该缝合部分设有多个大致呈环状的缝合针射出部分,且具有基部夹持件11的内窥镜7插入到插入部分3中。
接着,操作者例如利用插入到插入部分3中的内窥镜7、或安装到内窥镜7上的基部夹持件11、或经腹部插入的硬性镜47中的至少一个,通过检测来自基部12的发光元件34的位置信息,从而指定基部12的位置。此外,在基部夹持件11或经腹部插入的夹持件(例如,作为引导部件的夹持钳子48)的引导下,所述基部12通过第一和第二组织由基部夹持件11来夹持固定。之后,操作者通过插入部分3的缝合部分4和基部12进行缝合处理。
另外,尽管在上述缝合处理过程中,描述了这样一种情况,其中经腹部插入的硬性镜47和夹持钳子48分别用作用于检测来自基部12的位置信息的位置信息检测部件和用于基于检测到的位置信息来引导基部12的引导部件,但是所述处理过程并不限于此。例如,可以通过利用安装在插入部分3上的内窥镜7和基部夹持件11来构成所述引导部件。
如上所述,组织缝合器这样构成,从而基部12设置有发光部件34,且通过基于来自发光部件34的位置信息确定基部12的位置,由通过插入部分3插入的内窥镜7的基部夹持件11来夹持基部12以使其相对于缝合部分4被固定。
据此,通过由经腹部插入的硬性镜47检测基部12的位置信息并利用同样经腹部插入的夹持钳子48可以执行高精度的引导,且所述基部能被牢固地夹持以被迅速且容易地固定。
例如,在夹持钳子48的辅助下,通过使基部12位于这样的组织中,例如靠近插入部分3的缝合部分4的大肠腔,操作者能通过内窥镜经腹腔确定基部12并容易执行吻合操作。
此外,据此,可以切除并使大肠等的管腔吻合,而不用切割肠腔壁,并且高可靠性地和高精度地进行切割和吻合处理。
此外,安装到内窥镜7上的基部夹持件11的基部夹持部分的结构并不限于上述说明的结构,而是即使在该结构如图10、11、12、13和14所示构成的情况下也能同样有效。但是,在图10至图14中,与图1至图9中相同的部分用相同的标号表示且省略对它们的说明。
根据图10的基部夹持部分的结构,基部夹持部分50包括:操作线51,其连接到近侧控制部10并插入到护套52的远端部分中;和一对夹持臂54,其设置成在操作线51的远端部分处可打开和可闭合。该对夹持臂54设置成在从护套52的远端部分突出的状态下可展开,且其远端侧设有夹持槽53和中空部分55,夹持槽53具有能装配到基部12的轴30的装配槽33中的开口部分直径,而中空部分用于容纳基部12的远端夹持部分32。
此外,根据图11和图12的基部夹持部分的结构,基部56的轴部件57的远端侧顺序设有装配槽58和远端夹持部分59,且远端夹持部分59的远端侧设有磁铁部件60,该磁铁部件还用作位置信息传送部件。此外,与基部56结合使用的基部夹持部分61的远端部分设有凹入部分62,该凹入部分与轴部件57的装配槽58相对应。此外,与磁铁部件60相配合的、兼用作位置信息传送部件的磁铁部件63轴向可移动地容纳在凹入部分62中。磁铁部件63与操作线64连接,从而在近侧控制部10的操作下可以前后移动。
在上述结构中,将基部56插入例如小肠等的管腔内,使基部夹持件61靠近基部56,通过操作近侧控制部10挤出操作线64,且磁铁部件63从基部夹持部分61突出。这样,磁铁部件63和基部56的磁铁部件60通过之间的磁力而相互吸引,从而相互靠近以磁耦合。在这种情况下,通过操作近侧控制部10再次拉动操作线64,将轴部件57拉到基部夹持部分61的内部中,且使突出部分62装配到装配槽58中从而被固定夹持(参见图12)。通过磁铁部件60和磁铁部件63之间的磁力作用,可以进一步促进夹持和固定操作的确认信息。
根据图13和图14的基部夹持部分的结构,作为基部夹持部分65,连接到近侧操作部分10上的操作线68插入到操作管67中,且操作管67沿轴向方向可移动地插入到插入护套66中。此外,操作管67的远端具有一对能打开和闭合的夹持臂71,该对夹持臂在从插入护套66突出的状态下处于展开状态。该对夹持臂71的远端侧设有夹持槽69和中空部分70,该夹持槽具有装配到轴部件57的装配槽58的开口直径(参照图11),且该中空部分用于容纳远端夹持部分59。
此外,设置在操作线68的远端处的磁铁部件72与基部56的轴部件57的磁铁部件60相对应,并通过沿轴向方向随着操作管67在插入护套66中移动而从插入护套66的远端伸出和缩回到该远端。
在上述情况中,首先操作者在通过操作近侧控制部10而挤出操作管67和操作线68的状态下,使基部保持部分65靠近插入到管腔(例如,小肠等)中的基部56。然后,基部56的磁铁部件60和操作线的磁铁部件72相互吸引靠近且磁耦合。
接着,将操作线68拉入操作管67,并将操作管67拉入插入护套66。之后,通过上述拉动操作使操作管67的该对夹持臂71闭合,夹持槽69装配到基部56的轴部件57的装配槽58中,且基部56被基部夹持部分65夹持固定。
此外,虽然在说明书所述实施例的过程中,说明了使位置信息传送部件利用LED等的发光部件34和磁铁部件60,63的磁力的情况,但是位置信息传送部件并不限于此。例如,位置信息传送部件可以构成为传送诸如可见光等的电磁波作为位置信息。位置信息传送部件和用于检测位置信息的位置检测部件可以是将电能转换为可见光等的光能的部件,例如LED半导体或液晶冷光屏、半导体激光器、利用发光氨通过化学反应的发光元件、或发出通过从内窥镜发出的光而感应产生的荧光的荧光物质。
在这种情况下,尤其是,由于在体腔内易于检测到这些颜色的荧光,因此通过绿色或蓝色的荧光可以获得期待的效果。
此外,发出的光(电磁波)能量不限于可见光的能量,而可以是,例如具有超短波长的无线电波、X射线,γ射线等,或具有较长波长的红外线等的能量。此外,作为待传送的能量,还可以有效地利用超声波等的振荡能或声能。作为检测位置信息的方法,除了检测设置在内窥镜的远端处的CCD等的光,还可以采用通过天线检测无线电波、通过霍尔元件等检测磁场、通过闪烁器检测放射线、通过变换器检测超声波等的方法。
此外,尽管在第一实施例中,说明了这样的情况,其中基部夹持件11作为处置工具通过内窥镜7插入到插入部分3中,但是第一实施例并不限于此。例如,基部夹持件11可以直接插入到插入部分3的内窥镜插入管路6中。
图15和图16示出了根据本发明第二实施例的组织缝合器的主要部分。图15表示夹持状态,而图16表示缝合状态。顺便说一句,图15和图16中与第一实施例相同的部分用相同的标号表示,且省略对它们的说明。
也就是说,缝合部分76设置在插入部分3的远端部分处,且插入有大致为环状的缝合针容器77。缝合针容器77的远端面设有用于穿透的多个缝合针容纳孔78,这些缝合针容纳孔呈环状设置为两排。缝合针容纳孔78设置成使得所述孔的位置在外侧和内侧上相互轮替。缝合针容器78的近侧端设有形式为追随缝合针容纳孔78的环状缝合针滑动狭缝79,如图17和图18所示。
缝合针容纳孔78容纳有大致为马碲状的缝合针80,该缝合针相应地构成缝合用的缝合针部件,且缝合针80的近侧相对地设有缝合针挤压部件84。缝合针挤压部件84设有突出部分82,该突出部分与缝合针80接触并与设置在缝合针容纳孔78的近侧上的突出部分81接触。缝合针挤压部件84还设有突出部分83,该突出部分突入到突出部分81的近侧上的缝合针滑动狭缝79中。缝合针挤压部件84的突出部分83设有倾斜面。
此外,缝合针容纳部件77在缝合针容纳孔78的内周侧上设有大致为环状的刀具部件插入孔85。另外,缝合针容器77的近侧设有大致为圆柱形的转动部件86,该转动部件在其远端侧具有一平面,该转动部件能绕着内窥镜插入管路6的轴线转动。转动部件86的远端面设有大致为板状的缝合针滑块87。缝合针滑块87的远端部分设有一倾斜面,且该倾斜面待与突出部分83的倾斜面接触(参见图17)。另外,缝合针滑块87的内周侧设有大致为薄板状的刀具部件88。刀具部件88的刃尖从缝合针容纳部件77朝向远端侧突出,并插入通过刀具部件插入孔85。
转动部件86的近侧形成为大致圆柱形,其内壁侧设有齿轮(未示出),且齿轮部件89与该齿轮(未示出)啮合。驱动齿轮90与齿轮部件89啮合。该驱动齿轮通过电缆91连接到电动机单元15,且通过由电缆91从电动机单元15传送的驱动力被驱动转动。
缝合针容器77的远端侧被盖部件92覆盖。该盖部件92具有多个缝合针插入孔93,这些插入孔大致成环状设置为两排且处于与缝合针容纳孔78相对的位置,且缝合针插入孔93的内周部分设有与刀具插入孔85对应的中心孔94。此外,在盖部件92和缝合针容器77之间的间隔中,接合地设置有弹簧部件95,该弹簧部件相对于缝合针容器77朝向远端方向推动盖部件92。由于设置在盖部件92的近侧内壁上的突起抵靠缝合针容器77的突起部件96,因此盖部件92不与缝合针容器77分离。
此外,基部98大致在其中心部分处设有轴部件100,该轴部件待由通过内窥镜插入管路6插入的基部夹持件99固定夹持。另外,轴部件100的周围部分设有多个凹入部分101,这些凹入部分呈环状设置为两排且处于与缝合针容纳孔78和缝合针插入孔93相对的位置处。而且,刀具接收狭缝102设置在与刀具插入孔85相对的位置处。
另外,虽然在图15和图16中没有示出,但是与第一实施例类似,基部98在轴部件100中设有,例如发光部件34作为位置信息传送部件,且位置信息通过发光部件34被发送。
在上述情况中,当缝合诸如胃壁103和小肠壁104的腔壁时,首先,操作者将胃壁103和小肠壁104放置在缝合部分76和基部98之间。操作者根据来自基部98的位置信息,通过操作与内窥镜7成一体的基部夹持件99来夹持基部98的轴部件100,从而完成该过程,其中内窥镜7通过插入部分3而被插入。在这种状态下,当操作者将基部夹持件99拉入到内窥镜插入管路6中时,盖部件92抵抗弹簧部件95的偏压力而按压所述近侧。从而,刀具部件88的刃尖从盖部件92的远端面通过刀具部件插入孔85和中心孔94突出,且当穿透胃壁103和小肠壁104时接收在刀具接收狭缝102中。这样,缝合部分76、胃壁103、小肠壁104和基部98相互紧密接触(参照图16,图18)。
在这个阶段,操作者驱动插入部分3的电动机单元15。然后,电动机单元15的驱动力被传送给电缆91以使其转动,且转动部件86通过驱动齿轮90和齿轮89被驱动转动。转动元件86的转动使缝合针滑块87移动,从而在缝合针滑动狭缝79中与突出部分83的倾斜面滑动接触,并朝向远端侧挤压缝合针挤压部件84和缝合针80。之后,缝合针80的足部通过经由缝合针插入孔93插入而穿透胃壁103和小肠壁104,并与设置在与其相对位置处的基部98的凹入部分101接触。所述足部被折叠从而沿凹入部分101弯曲到内侧,以将胃壁103和小肠壁104缝合在一起。
同时,缝合针滑块87使刀具部件88随着转动部件86的转动而沿着刀具插入孔85转动,从而用穿透胃壁103和小肠壁104的刃尖部分切除胃壁103和小肠壁104。
根据第二实施例,通过利用大致为板状的刀具部件88来切割环状的组织,从而可以缓解作用到缝合针挤压部件84、刀具部件88等的构成件和组织上的力。因此,通过缓解作用到组织上的力的大小,可以防止组织损伤,诸如清创术等。而且,随着驱动力的减小,可以实现较小直径的驱动电缆91并简化结构。
图19表示根据本发明第三实施例的组织缝合器的主要部分。顺便提及,图19中与第一实施例相同的部分用相同的标号表示,且省略对它们的说明。
也就是说,基部150形成有基部远端部分151,该基部远端部分在基部主体152的一端面处具有球面(参照图19和图20),并且构成另一面的基部主体152的近侧突出以设置有轴部件158,该轴部件在其大致中心部分处具有远端夹持部分159。此外,基部主体152的周围部分在其多个部分(例如,在其大致为交叉形状的四个部分)处设有凹入形状的基部臂容纳部分153。基部臂容纳部分153设有构成缝合针接收件的基部臂155,从而能通过其枢转轴154而折叠和展开。
基部臂155分别在枢转轴154和突出部分156之间接合安装有盘簧部件157,以沿展开方向施加偏压力,且当基部臂155通过盘簧部件157的偏压力而绕枢转轴展开时,基部臂155沿周向从基部主体152突出。此外,基部臂155能抵抗盘簧部件157的偏压力而反向转动,以折叠容纳在基部臂容纳部分153中。由此,基部150的外形变得与基部主体152的外形尺寸大致相同,从而变成所谓的小直径形式。
基部臂155分别在其近侧设有凹入形状的锁定部分163,且径向形成在操作线165一端处的突出部分164选择地被相应的锁定部分163锁定。操作线165的中部松散地插入到设置在轴部件158上的线插入管路161中且沿轴向可移动。操作线165的基端部分设置有操作部分162,且操作部分162突出到设置在轴部件158上的狭缝160从而能被操作而沿轴向移动。操作线165沿基部主体的方向通过弹簧部件166被施加有偏压力。当操作部分162被基部夹持件170夹持时,操作部分162抵抗弹簧部件166的偏压力朝近侧方向移动,且多个突出部分164分别与基部臂155的锁定部分163分离。
此外,虽然图中未示出,但是与第一实施例类似,对应于例如轴部件158,基部150设有,例如发光部件34作为位置信息传送装置,且位置信息通过发光部件34传送。
另一方面,构成组织缝合器的插入部分169的远端侧设有缝合部分172。缝合部分172在其大致为交叉形状的四个部分处例如设有与基部150的基部臂155对应的宽度较宽部分172a。宽度较宽部分172a的形状设置为对应于基部臂155展开的状态,且与第一实施例相似,设有例如缝合针容纳孔20和刀具部件插入孔22。此外,缝合部分172设有内窥镜插入管路178,该内窥镜插入管路同样插入有内窥镜7,而内窥镜插入有基部夹持件170。
在上述情况中,操作者在使基部臂155围绕待容纳在基部臂容纳部分153中的枢转轴折叠的状态下,例如经口腔将基部150插入到作为管腔的小肠168中。另一方面,操作者例如经口腔将插入部分169插入到作为管腔的胃167中,切割胃167的一部分以从其开口部分171到达体腔(参照图21)。在这种情况下,操作者根据来自基部150的位置信息确定基部150在小肠168中的位置,切割小肠168的相应部分。操作者通过插入部分的基部夹持件170将基部轴部件158以及远端夹持部分159和操作线165的操作部分162夹持在一起(参照图22)。
接着,操作者将基部夹持件170引入到插入部分中。然后,操作线165的操作部分162通过基部夹持件170抵抗弹簧部件166的偏压力朝向近侧移动,且突出部分164与基部臂155的锁定部分163分离。由此,基部臂155通过盘簧部件157的偏压力绕枢转轴沿展开方向枢转,从而与基部臂容纳部分153分离而展开。同时,当基部夹持件170被拉入插入部分169中时,基部150的基部臂155通过将胃壁和小肠壁插设在其与缝合部分172的宽度较宽部分172a之间而与缝合部分172的宽度较宽部分172a接触。
在这个阶段,操作者通过操作插入部分169的控制部10(参照图1),从缝合部分172的缝合针插入孔172c挤出缝合针(为了图示方便未在图23中示出)。之后,挤出的缝合针21的远端部分通过穿透胃壁和小肠壁(参照图23)被按压到基部臂155的凹入部分(未示出)中进行缝合。之后,刀具部件172e从缝合部分172的刀具部件插入孔172d被挤出,其被缝合的内周侧呈环状被切割且形成了吻合孔173,如图24所示。
根据第三实施例,通过可容易地将基部150插入到管腔中并且通过可实现较大直径的缝合,能进一步改善处理操作性。
此外,根据第三实施例,在缝合过程中可以精确地设定缝合部分172与基部150之间的位置关系。此外,据此,通过操作使内窥镜7和基部夹持件170扭转而可以调节缝合部分172和基部150之间的位置关系,因此能方便、容易且准确地夹持固定所述缝合部分172和基部150。
此外,基部的结构并不受上述情况的限制,相反该结构还能如图25所示构成。顺便说一句,图25中与图19至图24相同的部分用相同的标号表示,且省略对它们的详细说明。
也就是说,在图25中,基部主体151的轴部件158的根侧设有大致为六角形状的突出装配部分158a。此外,基部结构这样构成,即,在内窥镜插入管路178的远端侧上形成大致为六角形状的凹入装配部分172b,该内窥镜插入管路位于插入部分169的缝合部分172中,且所述基部150在将基部主体151的凹入装配部分158a装配到凹入装配部分172b上的状态下被固定夹持。从而,可以准确地设定基部150和缝合部分172之间的位置关系并能实现良好的效果。
下面,将参照附图说明组织缝合器的第四实施例。
图26表示根据第四实施例的组织缝合器,其包括:待插入到大致柔性的组织中的插入部分112;设置在插入部分的远端侧上的缝合部分111;设置在插入部分的近侧上的操作部分113;和设置在缝合部分111的远端侧上的基部部分114。
其中一操作轴115在基部部分114的近侧上延伸。操作轴115设置成能在操作轴插入管路116中前后移动,该操作轴插入管路用于从其远端到近侧连通缝合部分111、插入部分112和操作部分113。近侧从操作部分113突出,且夹持部分119设置在近侧的端部处。
此外,基部部分114设有内窥镜插入管路121,该内窥镜插入管路朝向所述基部部分的远端侧开口、与近侧连通并与操作轴115连通,且内窥镜131可操作地通过内窥镜插入管路121插入。内窥镜插入管路121在远端侧和近侧上设有气密阀117,118,且在它们之间设有预定间隔。另外,操作轴115在侧壁部分处设有多个吸引孔120,这些吸引孔以朝向远端侧挤出的方式设置在基部部分114和缝合部分111之间,且在近侧上的端部设有与内窥镜插入管路121连通的吸引接口122。该吸引接口122与吸引源(未示出)连接,以通过该吸引源抽吸操作轴的内部。
缝合部分111在其远端侧大致形成为圆柱形状,并在其近侧上设有操作轴插入管路116,而且所述操作轴插入管路116中插有操作轴115。
另外,缝合部分111包括缝合针容器123,该容器具有朝向近侧操作部分113延伸的管部件。缝合针容器123的远端侧设有多个贯穿缝合针容器123的缝合针容纳孔124,这些容纳孔大致成环状布置成两排。缝合针125分别容纳在缝合针容纳孔124中。
缝合针容器123的近侧设有大致为圆柱形的移动部件126,该移动部件设置成能与操作轴插入管路116同轴地朝向远端和后方移动。移动部件126的远端面设有多个缝合针挤压部件127,每个缝合针挤压部件均大致为薄板形状且位于与缝合针容纳孔124相对的位置处。此外,在移动部件126的近侧的壁面上,从插入部分112的远端朝向近侧连通的挤压部件129延伸到近侧操作部分113。挤压部件129设置成在挤压部件插入管路128中可移动,该挤压部件插入管路安装在操作轴115的外部。
另外,基部部分114近侧上的端面设有凹入部分130,这些凹入部分设置在与缝合针容纳孔124相对的位置处。
操作部分113突出以提供用于夹持的夹持部件132,且夹持部件132的大致根部设有手柄部件134,该手柄部件能以轴133为中心枢转。手柄部件134通过连杆135与操作环144连接。操作环144设置成能与操作轴插入管路116同轴地前后移动并连接到挤压部件129上。
此外,操作部分113的内侧设有大致为杆状的突出部分137,该突出部分从近侧向内侧突出。突出部分137设置成与可弹性变形的悬臂弹簧部件136相对并被该悬臂弹簧部件136选择地弹性锁定,该悬臂弹簧部件设置在操作轴115的侧部上。另外,弹簧部件138接合地安装在操作轴115的突出部分137和缝合针容器123之间。
此外,操作部分113设有与悬臂弹簧部件136相对的切换孔139,且切换孔139设有能被操作按压的切换件140。切换件140与操作轴115的悬臂弹簧部件136相对,通过操作按压切换件140来按压悬臂弹簧部件136并使操作部分113解除被突出部分137锁定。由此,操作轴115通过弹簧部件138的偏压力被偏压朝向近侧移动。
在上述情况中,组织缝合器进行所谓的逆流性食道炎的治疗处理,以例如在胃-食道接合部分143处形成阀结构,该接合部分是组织在贲门处的缝合部分。
也就是说,操作者在插入到操作轴115中的内窥镜131的视野范围内,将包括基部部分114的插入部分112的缝合部分111经口腔插入到胃-食道接合部分143中。接着,操作者克服弹簧部件138的压缩力挤压从操作部分113突出的操作轴115。然后,基部部分114从缝合部分111朝向远端侧伸出,并在基部部分114和缝合部分111的远端面之间形成有空间,如图26的剖视图所示。在这种情况下,悬臂弹簧部件136与将被保持的操作轴115的突出部分137接触,并通过其远端部分将切换件140向上按压到操作部分113的外部。在这种情况下,操作者通过使插入到胃141中的内窥镜131反向旋转来调节基部部分114的位置,从而将所述空间调节设置在胃-食道接合部分143的适当位置处。
在这个阶段,操作者驱动吸引源(未示出),该吸引源与设置在操作轴115的夹持部分119处的吸引接122连接。然后,抽吸操作轴115的内部,且食道142被吸引到形成在基部部分114和缝合部分111之间的空间中(参照图27)。接着,操作按压操作部分的切换件140。这样,操作轴115通过弹簧部件138的偏压力朝向近侧方向被按压返回,且食道142被夹持在基部部分114与缝合部分111之间。
接着,当握持手柄134时,操作环144沿远端侧方向移动,而挤压部件129、移动部件126和缝合针挤压部件127沿远端侧方向移动。在这个阶段,缝合针挤压部件127使缝合针125从缝合针容纳孔127伸出,缝合针125的远端部分刺穿食道142并与基部部分114的凹入部分130接触,且所述远端被折叠弯曲到内侧从而在食道的整个周边上缝合食道(参照图28)。
根据第四实施例,通过经口腔的方法且在一个动作中能在整个周边上缝合食道-胃接合部分,在胃-食道接合部分处能容易地形成希望的阀,且因此针对逆流性食道炎能实现较高的治疗效果。此外,根据这种情况,通过在内窥镜的视野范围内确定待缝合的位置来执行缝合,因此能实现方便、容易且正确的治疗。
另外,图29表示根据第五实施例的组织缝合器,设置在远端侧的基部部件176突出以在其近侧提供操作轴部件177。基部部件176和操作轴部件177形成有从远端侧到达近侧的内窥镜插入管路178。缝合器主体179安装在操作轴177外部从而能朝远端并向后移动,且缝合针按压部件180插入到缝合器主体179的外周部上从而能前后移动。内窥镜插入管路178插入有内窥镜181且其近侧设有近侧操作部分(未示出)。
另一基部部件176的外周壁沿轴向方向(朝远端和向后方向)设有多个狭缝部分182,这些狭缝部分之间有预定的间隔(参照图30)。另外,缝合器主体179的远端侧设有多个锁定缝合针容纳狭缝部分183,这些部分以预定的间隔与狭缝部分182相对设置。锁定缝合针容纳狭缝部分183被固定以将锁定缝合针部件184的近侧端部容纳在位于近侧远端部的固定位置185处。
根据锁定缝合针部件184,在所述近侧,其远端侧形成为具有朝向缝合器主体179的外侧方向开口的倾斜角,且其缝合针远端部分设置成朝向缝合器主体179的远端部分的外侧和缝合器主体179的周壁开口。此外,缝合针按压部件180的远端侧设有多个容纳在狭缝部分182和锁定缝合针容纳狭缝部分183中从而能朝向远端和后方移动的限制突起186,这些突起之间设有预定间隔。
另外,缝合器主体179的远端部分设有多个位于锁定缝合针容纳狭缝183之间的缝合针容纳孔187,这些容纳孔187与形成在近侧上的基部部件176的侧面、用于弯折缝合针的凹入部分(未示出)相对应。
在上述构成中,首先,操作者通过操作拉动操作轴部件177而使基部部件176大致与缝合器主体179接触,并使缝合针按压部件180沿远端侧方向移动。之后,通过缝合针按压部件180的限制突起186来按压锁定缝合针部件184,使其容纳在基部部件176的锁定缝合针容纳狭缝部分182中。
在这个状态下,内窥镜181通过内窥镜插入管路178而插入,整个装置经口腔沿内窥镜181插入到食道-胃缝合部分189。接着,操作者在反向观察胃内的内窥镜181的同时,通过使操作轴部件177伸出,从而在基部部件176与缝合器主体179的远端部分之间形成有空间,如图29的剖视图所示。在这个阶段,当操作者将缝合针按压部件180收回到近侧时,锁定缝合针部件184朝向缝合针按压部件180的外周侧伸出。
在这个状态下,整个装置经口腔被按压以向前移动,锁定缝合针部件184刺穿食道188的肌肉层(参照图31),之后,缝合针按压部件180被按压向前移动到缝合器主体179。然后,通过使缝合针按压部件180的限制突起186与锁定缝合针部件184接触而朝向所述远端侧移动,锁定缝合针部件184再次容纳在锁定缝合针容纳狭缝部分183中。从而,食道188被拉入到形成在基部部件176和缝合器主体179的远端之间的空间内。通过在这个状态下拉动操作轴部件177,食道188在基部部件176和缝合器主体179的远端之间被刺穿,且之后操作一控制部(未示出),从而通过设置成容纳在缝合器主体179中的缝合针(为了图示简便而未示出)基本在食道的整个周边上缝合食道组织。
根据该第五实施例,通过锁定缝合针部件184以机械的方式下拉所述食道组织,且通过在包括肌肉层的所有层处缝合食道组织的整个周边,从而能在食道-胃接合部分处形成阀结构,因此所形成的阀能承受长时间使用。
此外,虽然根据上述实施例,说明了在整个周边上缝合组织的情况,但是所述实施例并不限于此,而是例如,待缝合的位置也可以被限定为食道-胃接合部分的一部分,例如其三分之一或二分之一的周边。由此,例如在病人的症状比较轻微的情况下,不需要在整个周边上形成阀结构,并且通过相反地限制所缝合的部分,减少用于下拉所缝合的部分、基部和食道组织的锁定缝合针部件的数量和外径,可以减少组织缝合器的插入部分的外径并能缓解在插入所述组织缝合器时对病人造成的负担。
虽然已经参照了本发明的优选实施例对本发明进行了表示和描述,但是当然应理解在不脱离本发明的精神的情况下,能容易地在形式或细节方面做出不同的修改和变化。因此,本发明并不限于所描述和示出的具体形式,而是应覆盖可能落在所附权利要求的范围内的全部变形。
Claims (11)
1、一种组织缝合器,其包括:
插入部分,设有内窥镜插入管路;
缝合部分,设有缝合针射出部分,该缝合针射出部分设置在所述插入部分的远端侧;
缝合针接收部件,其与所述插入部分分开设置,用于在通过组织与所述缝合部分相对的状态下,被通过所述插入部分引入的处置工具夹持和固定,所述缝合针接收部件使从所述缝合部分的缝合针射出部分射出并穿过所述组织的缝合用的缝合针部件的远端部分弯曲;和
位置信息传送部件,其设置在所述缝合针接收部件中用于传送位置信息。
2、如权利要求1所述的组织缝合器,其特征在于,还包括:
位置检测部件,用于通过接收来自所述位置信息传送部件的位置信息来检测所述缝合针接收部件的位置;和
引导部件,用于根据所述位置检测部件检测到的信息来引导所述缝合针接收部件。
3、如权利要求2所述的组织缝合器,其特征在于,所述位置检测部件设置在通过所述插入部分引入的内窥镜和所述处置工具的至少一个上,且所述引导部件由通过所述插入部分引入的处置工具或内窥镜构成。
4、如权利要求2所述的组织缝合器,其特征在于,所述位置检测部件和引导部件中的至少一个包括经腹部引入的内窥镜和处置工具。
5、如权利要求1所述的组织缝合器,其特征在于,所述缝合针接收部件利用磁力被夹持并固定到所述处置工具上。
6、如权利要求1所述的组织缝合器,其特征在于,所述缝合部分包括刀具部件,用于切割所述缝合针射出部分的内周部分。
7、如权利要求1所述的组织缝合器,其特征在于,所述缝合针接收部件这样构成,以使其设有夹持部分的主体的直径小于所述缝合部分的直径,多个臂部分设置在所述主体上从而能被折叠和展开,且在所述夹持部分处被夹持的状态下,所述多个臂部分从折叠位置展开到与所述缝合部分相对的位置处。
8、如权利要求1所述的组织缝合器,其特征在于,所述缝合部分设有多个大致为环状的缝合针射出部分。
9、一种组织缝合器的缝合针接收部件,其包括:
位置信息传送部件,用于输出电磁波以通知其位置。
10、如权利要求9所述的组织缝合器的缝合针接收部件,其特征在于,所述位置信息传送部件输出光作为所述电磁波。
11、根据权利要求9所述的组织缝合器的缝合针接收部件,其特征在于,还包括:
轴部件,其构成由处置工具夹持的部件并包括所述位置信息传送部件。
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EP1616526B1 (en) | 2007-12-26 |
US20090212088A1 (en) | 2009-08-27 |
JP2006026013A (ja) | 2006-02-02 |
EP1616526A1 (en) | 2006-01-18 |
US7694864B2 (en) | 2010-04-13 |
DE602005003985T2 (de) | 2008-12-11 |
JP4257270B2 (ja) | 2009-04-22 |
DE602005003985D1 (de) | 2008-02-07 |
US20060011698A1 (en) | 2006-01-19 |
CN100473361C (zh) | 2009-04-01 |
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