CN1969769A - 外科夹具、施放器装置和它们的使用方法 - Google Patents

外科夹具、施放器装置和它们的使用方法 Download PDF

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CN1969769A
CN1969769A CNA2006101468457A CN200610146845A CN1969769A CN 1969769 A CN1969769 A CN 1969769A CN A2006101468457 A CNA2006101468457 A CN A2006101468457A CN 200610146845 A CN200610146845 A CN 200610146845A CN 1969769 A CN1969769 A CN 1969769A
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anchor clamps
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查德·保罗·布德罗克斯
马克·S·奥尔蒂斯
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Abstract

提供一种外科夹具，用于结扎或横切组织，例如脉管、其他管道等，还提供一种外科夹具施放器，用于将夹具输送和施放到组织上。外科夹具包括脊状部和从脊状部延伸的相对的臂，其中所述臂可限定夹紧长度。在停靠状态，夹具可被偏压到闭合位置，从而每个相对的臂的端部彼此相邻。通过这种偏压，当例如用外科夹具施放器将夹具施放到组织上时，夹具可以沿着夹紧长度对组织施加正的夹紧力，以密封组织并限制例如血液的流体从组织流过。

Description

外科夹具、施放器装置和它们的使用方法
技术领域
本发明总的涉及一种外科装置，更具体地说，涉及外科夹具、外科夹具施放器以及用于结扎脉管、其它管道等的方法。
背景技术
近年来，由于腹腔镜和内窥镜外科手术的进行，外科学得到了显著的发展。内窥镜手术通过自然的开口进行，而腹腔镜外科手术通常通过如套管针组件的接入端口进行，所述套管针组件是用于穿刺体腔的外科器械。套管针通常包括尖的闭塞器尖端和套管或插管。通过使用闭塞器尖端穿刺皮肤，将套管针插管插入皮肤，以进入体腔。在穿刺之后，移出闭塞器，套管针插管保持在体内。
在许多外科手术过程中，外科医生必须在切割各种血管、管道和其它组织之前将它们闭合或结扎，以防止过度的流血，减少病人发生其它并发症的危险。有时还需要通过切割来横切脉管、管道或器官，然后用诸如直线型切割器/缝合器密封脉管、管道或器官。
通常用于腹腔镜或内窥镜外科手术中结扎脉管、管道或器官的一种外科器械是外科夹具施放器，其用于在外科手术期间结扎脉管、管道、旁路或者一部分身体组织。夹具施放器通常具有手柄，该手柄具有细长轴，该细长轴的端部上具有一对可动的相对夹钳，用于在其间保持和形成结扎夹具。所述夹钳围绕脉管定位，通过夹钳使夹具机械变形，从而将夹具固定到脉管上。
用于结扎脉管的一些现有的夹具的一个缺点在于，夹具的腿部往往在从夹具施放器上释放之后一定程度地分开。这种现象称为鸭嘴式分离。鸭嘴式分离可导致脉管结扎不充分，从而导致过多的血液流失和/或对脉管造成不必要的损害。另外，结扎夹具通常难以进入夹具施放器的夹钳内，因为组织和夹具腿部上的夹持结构之间存在阻力，所述组织位于夹钳之间。
尽管存在一些现有的技术，但仍需要改进的外科夹具施放器、夹具和用于结扎和横切组织(例如血管、其它管道等)的方法。
发明内容
本发明的实施例总的提供外科夹具、夹具施放装置以及结扎和横切组织的方法。
在一个方面，提供一种外科夹具，其包括脊状部，该脊状部具有由顶部边缘和顶部边缘限定的高度，并且沿着夹具的纵向轴线从第一夹具端部到第二夹具端部延伸。该外科夹具还包括相对的臂，所述相对的臂从所述脊状部顶部边缘和顶部边缘延伸，所述臂被偏压到闭合位置，从而相对的臂中的每一个的端部彼此相邻，以限定具有一长度的组织夹紧区域，夹紧长度由所述臂限定。外科夹具的相对的臂可具有沿着夹具的长度设置的一个或多个狭槽，每个狭槽从每个相对的臂的端部朝着脊状部沿基本上垂直于夹具的纵向轴线的方向延伸。在一个实施例中，所述外科夹具沿着所述长度在一个或多个位置易折断，从而可选择地控制所述组织夹紧区域的长度。另外，所述夹具的脊状部可沿着纵向弯曲，从而可选择地改变所述夹具的形状。
在另一个方面，提供一种外科紧固件输送系统，其包括输送装置，该输送装置夹具供应器和夹具打开机构。输送装置具有手柄和从手柄延伸的细长轴。所述细长轴在远端具有相对的夹钳，所述夹钳可操作，以在分开的打开位置和闭合位置之间运动。该系统还包括外科夹具供应器，其适于设置在所述输送装置内。所述外科夹具供应器包括至少一个外科夹具，所述外科夹具具有脊状部和从脊状部延伸的相对的臂，所述臂被偏压到闭合位置，从而每个臂的端部彼此相邻，限定一夹紧区域。所述夹具打开机构设置在所述输送装置内，操作所述夹具打开机构可以将所述至少一个外科夹具从闭合位置定位到打开的输送位置，从而每个臂的端部位于限定组织收纳空间的分开位置。在一个实施例中，输送装置还可包括设置在所述输送装置内的切割元件，所述切割元件可选择地相对于细长轴的远端从回缩位置运动到伸出位置，操作所述切割元件可切开位于相对的夹钳之间的组织。
在又一个方面，提供一种用于施放外科夹具的方法，包括：提供具有相对的臂的外科夹具，所述相对的臂被偏压到闭合位置，从而每个相对的臂的端部彼此相邻；克服外科夹具的偏压力，以将相对的臂分开到打开位置；将外科夹具施放到待结扎或横切的组织上；以及使夹具闭合，以结扎或横切组织。
本发明还涉及如下方面：
(1)一种外科夹具，包括：
脊状部，具有由顶部边缘和顶部边缘限定的高度，并且沿着夹具的纵向轴线从第一夹具端部到第二夹具端部延伸；以及
相对的臂，从所述脊状部顶部边缘和顶部边缘延伸，所述臂被偏压到闭合位置，从而相对的臂中的每一个的端部彼此相邻，以限定组织夹紧区域，所述组织夹紧区域具有由所述臂限定的夹紧长度。
(2)如第(1)项所述的外科夹具，其中，所述外科夹具沿着所述长度在一个或多个位置易折断，从而可选择地控制所述组织夹紧区域的长度。
(3)如第(1)项所述的外科夹具，其中，所述夹具的脊状部可沿着纵向弯曲，从而可选择地改变所述夹具的形状。
(4)如第(1)项所述的外科夹具，其中，每个相对的臂包括沿着夹具的长度设置的一个或多个狭槽，每个狭槽从每个相对的臂的端部朝着脊状部沿基本上垂直于夹具的纵向轴线的方向延伸。
(5)如第(4)项所述的外科夹具，其中，每个狭槽终止于与脊状部相邻的位置。
(6)如第(1)项所述的外科夹具，其中，相对的臂的端部包括适于将夹具固定到组织上的组织夹持元件。
(7)如第(6)项所述的外科夹具，其中，第一臂的组织夹持元件可相对于相对的第二臂的组织夹持元件沿着所述长度摆动。
(8)如第(1)项所述的外科夹具，其中，切开元件一体地形成在第一夹具端部和第二夹具端部中的一个上。
(9)如第(1)项所述的外科夹具，其中，所述组织夹紧区域的长度大于所述脊状部的长度。
(10)如第(1)项所述的外科夹具，其中，每个相对的臂相对于脊状部成锐角定向。
(11)如第(1)项所述的外科夹具，其中，所述夹具由具有弹性的材料制成，所述材料选自金属、金属合金和聚合物。
(12)如第(11)项所述的外科夹具，其中，所述材料选自镍钛诺、不锈钢和弹簧钢。
(13)如第(11)项所述的外科夹具，其中，所述夹具由可生物吸收的聚合物制成。
(14)如第(13)项所述的外科夹具，其中，所述可生物吸收的聚合物选自聚乙醇酸交酯、聚二氧六环酮或聚二恶烷酮、聚交酯。
(15)如第(1)项所述的外科夹具，其中，相对的臂的端部在闭合位置彼此接触。
(16)如第(1)项所述的外科夹具，其中，相对的臂的端部在闭合位置彼此分开。
(17)一种外科紧固件输送系统，包括：
输送装置，具有手柄和从手柄延伸的细长轴，所述细长轴在远端具有相对的夹钳，所述夹钳可操作，以在分开的打开位置和闭合位置之间运动；
外科夹具供应器，适于设置在所述输送装置内，所述外科夹具供应器包括至少一个外科夹具，所述外科夹具具有脊状部和从脊状部延伸的相对的臂，所述臂被偏压到闭合位置，从而每个臂的端部彼此相邻，以限定一夹紧区域；以及
夹具打开机构，设置在所述输送装置内，操作所述夹具打开机构可以将所述至少一个外科夹具从闭合位置定位到打开的输送位置，从而每个臂的端部位于限定组织收纳空间的分开位置。
(18)如第(17)项所述的系统，其中，还包括设置在所述输送装置内的切割元件，所述切割元件可选择地相对于细长轴的远端从回缩位置运动到伸出位置，操作所述切割元件以切开位于相对的夹钳之间的组织。
(19)如第(17)项所述的系统，其中，还包括夹钳闭合组件所述夹钳闭合组件能够将相对的夹钳定位在分开的打开位置和闭合位置之间。
(20)如第(17)项所述的系统，其中，还包括夹具推进组件，所述夹具推进组件能够将外科夹具供应器的至少一个外科夹具从细长轴运动到相对的夹钳之间的位置。
(21)如第(17)项所述的系统，其中，所述夹具推进组件包括能够将至少一个外科夹具推向相对的夹钳的至少一个推杆和推进棘轮组件。
(22)如第(17)项所述的系统，其中，所述夹具打开机构包括设置在细长轴中的倾斜元件。
(23)如第(17)项所述的系统，其中，所述夹具打开机构可动地连接到细长轴上，并且当至少一个外科夹具朝着相对的夹钳运动以将至少一个外科夹具的臂保持在打开的输送位置时，操作所述夹具打开机构可使其沿着细长轴的纵向轴线平移。
(24)如第(17)项所述的系统，其中，所述相对的夹钳相对于细长轴的纵向轴线弯曲。
(25)一种用于施放外科夹具的方法，包括：
提供具有相对的臂的外科夹具，所述相对的臂被偏压到闭合位置，从而每个相对的臂的端部彼此相邻；
克服外科夹具的偏压力，以将相对的臂分开到打开位置；
将外科夹具施放到待结扎或横切的组织上；以及
使夹具闭合，以密封组织。
(26)如第(25)项所述的方法，其中，包括在将外科夹具施放到组织上之前将夹紧力施加到待密封的组织上。
(27)如第(26)项所述的方法，其中，包括在将外科夹具施放到组织上之前切开夹紧的组织。
附图说明
结合附图，可以从下述详细的描述更清楚的理解本发明，其中：
图1A是外科夹具的一个实施例的透视图；
图1B是图1A的外科夹具的端视图；
图2是外科夹具的另一个实施例的透视图，其具有将夹具的相邻臂部分分开的多个狭槽；
图3是外科夹具的另一个实施例的透视图，该外科夹具由多个可分离的夹具元件形成；
图4A是外科夹具施放器的一个实施例的透视图；
图4B是图4A的外科夹具施放器的透视图，示出了可从装置去除的仓组件；
图4C是图4A的外科夹具施放器的分解图；
图4D是图4B的仓组件的分解图；
图4E是图4C的仓组件的近侧部分的一部分被切去的示图；
图5A是图4A的夹具施放器的夹钳的透视图；
图5B是图4A的夹具施放器的一对相对的夹钳的侧视图；
图6A是图5B的相对的夹钳的替代实施例的透视图；
图6B是图6A的相对的夹钳中的一个的透视图；
图7是图4A的夹具施放器的相对的夹钳和夹钳闭合组件的侧面剖视图；
图8A是处于停靠状态的图4A的夹具施放器的可动手柄和夹钳闭合组件的侧面剖视图；
图8B是处于接合状态的图8A的可动手柄和夹钳闭合组件的侧面剖视图；
图8C是处于接合状态的图8B的夹钳闭合组件的锁定机构的侧视图；
图8D是图4A的夹具施放器的侧视图，其中相对的夹钳处于闭合状态；
图8E是图8B的夹钳闭合组件的锁定机构的侧视图，其处于脱离接合状态，使得相对的夹钳可以定位在打开状态；
图8F是图4A的夹具施放器的侧视图，其中相对的夹钳处于打开状态；
图9A是图4A的夹具施放器的端视图，其中具有夹具打开机构；
图9B是图4A的仓组件的远端的横截面透视图；
图9C是朝着图9A和图9B的夹具打开机构推进的夹具的透视图；
图9D是在图9C的夹具打开机构上进一步推进的夹具的透视图；
图9E是在图9C的夹具打开机构上完全推进的夹具的透视图；
图10A是设置于夹具内的夹具打开机构的替代实施例的透视图；
图10B是从夹具缩回的图10A的夹具打开机构的透视图；
图11是夹具从仓展开之后的图4A的夹具施放器的近端的侧面剖视图；
图12A是图4D的仓组件的推杆的近端的侧视图；
图12B夹具击发之后的图4D的仓组件的远端的局部切去的透视图；
图12C是图4D的仓组件的棘轮组件的侧面剖视图；
图13A围绕组织设置的图4A的夹具施放器的夹钳的透视图；
图13B图4A的夹钳的透视图，其处于闭合状态以接合组织；
图13C是图13B所示夹钳的截面透视图，其中一个夹钳去除，以显示其中的切割元件和夹具；以及
图13D是夹具施放到组织上之后，组织的透视图。
具体实施方式
现在将描述一些实施例，以提供对在此公开的原理、结构、功能、制造、装置和方法的使用的全面理解。附图中示例性示出了这些实施例的一个或多个例子。本领域技术人员理解的是，这里详细描述和附图中示例性示出的装置和方法是非限制性的示例性实施例，本发明仅由后附权利要求书限定。与一个实施例有关的所描述和示例性示出的特征可以和其它实施例的特征结合。这种改进和变型也涵盖在本发明的范围中。
本发明总的涉及用于结扎和横切组织(例如脉管、其它管道等)的外科夹具、用于将外科夹具施加到组织上的外科夹具施放器、以及结扎组织的方法。尽管这里描述的装置和方法是与用于结扎或横切脉管的装置有关，但本领域技术人员应当理解，这些装置和方法可以用于结扎或横切各种其它身体组织，包括但不限于静脉、动脉、管道、或者其它病人需要结扎的管状部分。
图1A-3示例性示出了外科夹具的示例性实施例。在一个实施例中，如图1A-1B所示，夹具10基本上为细长体，其具有纵向轴线32，脊状部12在第一和第二夹具端部10a、10b之间延伸。脊状部12具有由如图1B所示的顶部边缘12a和底部边缘12b以及从脊状部12的顶部和底部边缘延伸的相对的臂14、16限定的高度h，从而这些臂能够在其间夹住组织。臂14、16从第一夹具端部10a到第二夹具端部10b的长度限定了夹紧长度1。
本领域技术人员将会理解，夹具10可具有适于所需应用的物理特性。在如图1A和1B所示的一个示例性实施例中，在停靠状态下，夹具10被偏压到闭合位置，使得每个相对的臂14、16的端部彼此邻近，以限定其间的夹紧区域。在这种闭合位置中，臂14、16可以彼此相接触或者处于间隔开的关系。无论处于何种情况，产生的偏压是这样的，即当夹具10施放到组织上时，夹具10可以沿着夹紧长度1对处于夹紧区域的组织施加正夹紧压力，以密封组织并限制如血液的流体从组织经过。例如，当夹具10被施放到组织上时，夹具10处于打开的输送位置，其中臂14、16相对于彼此岔开，从而脊状部12和夹具10的臂14、16形成基本上U形(图9C)或者C形(图3)的通道17。当夹具10在组织上推进时，臂14、16保持在岔开位置，从而组织逐渐位于通道17中。当臂14、16被释放时，臂14、16回到偏压的闭合位置，从而臂14、16夹紧并密封其间的组织。
如上所述，夹具10具有夹紧长度1，当夹具10施放到组织上时，在组织上施加压力。本领域技术人员应当理解，夹紧长度可以相对与脊状部的长度变化。也就是说，夹紧长度可以大于、小于或者等于脊状部的长度。在一个实施例中，夹具10的夹紧长度1可以被选择地改变成与待结扎的组织的长度相对应。例如，夹具10可以沿着夹具10的纵向轴线在一个或多个位置34是易折断的，以允许夹紧10的夹紧长度1被缩短。具体地说，形成夹具10的材料可以在位置34处是如图1A所示的多孔的，或者是如图3所示是有划痕的，以允许夹具10分成一个或多个夹具元件36a-36n。在使用中，夹具10的所需长度(例如夹具部分36a和36b)施放到组织上，压力或者弯曲载荷可以围绕位置34b施加到夹具10上，使夹具10在位置34b折断，允许未使用的夹具元件36c-36n移出。
夹具10也可以具有可选择地改变的形状，从而夹具能够适应各种几何形状的组织。例如，夹具10可以是相对于夹具纵向轴线32可弯曲的。在一个实施例中，夹具10的物理构造可以影响夹具的适应性。具体地说，如图1A所示，夹具10可以包括狭槽19，使夹具10能够弯曲，以实现较大程度的适应性。如图1A所示，狭槽19比较短，并且从在臂处或者臂附近的位置沿于基本上与纵向轴线32垂直的方向延伸，并终止于脊状部12之前。在另一个夹具10′的实施例中，如图2所示，狭槽19′在每个相对臂14′、16′和与脊状部12′比较靠近的位置之间的较大距离上延伸。这种构造可以提供夹具10′较大程度的适应性，以允许夹具10′相对与纵向轴线32′挠曲。
夹具10可由各种能使装置偏压到闭合位置的材料制成，但在一个示例性实施例中，其由弹簧材料制成。例如，夹具10可由如金属、金属合金、或聚合物的弹簧材料制成。作为非限定性的例子，适合的材料可以包括弹簧钢、不锈钢、及其合金。夹具还可由超弹性材料支撑，例如钛和镍的合金(例如镍钛诺)，其在受到例如张力时改变形状，在去除作用力时回到其展开状态。另外，夹具10可以由可生物吸收的聚合物制成，例如作为非限定性的例子的聚乙醇酸交酯、聚二氧六环酮或聚二恶烷酮(polydioxanone)、聚交酯。
尽管夹具10可以偏压到闭合的组织夹紧位置，但本领域技术人员理解，夹具10的几何构造也可影响相对臂14、16的偏压。例如，夹具10可以包括设置在相对臂14、16和脊状部12之间的弯曲部分20，弯曲部分20可以使每个臂14、16相对于脊状部12形成锐角21。同样，当夹具10处于偏压的闭合位置时，弯曲部分20使臂14、16的端部朝向彼此定向。
相对臂14、16可以包括能对脉管或管道提供更可靠的结扎的部件。例如，相对臂14、16可包括从相对臂14、16延伸并沿着夹紧长度1设置的一个或多个组织夹持元件18。在使用中，当夹具10安置在一部分组织上时，组织夹持元件18接合组织部分，将夹具10固定到组织上，使夹具10相对于组织的无意运动最小化。本领域技术人员应当理解，组织夹持元件18可以各种方式沿着夹具10的长度1设置。在一个实施例中，第一臂14的组织夹持元件18可以相对于相对的第二臂16的组织夹持元件18沿着夹紧长度1摆动。例如，每个臂14、16包括设置在其间的将相邻的组织夹持元件18分开的狭槽19，其中第一臂14的每个组织夹持元件18与第二臂16的相对的狭槽19对准。作为另一种选择，夹具10的臂14、16可以非摆动的方式构成，使每个臂的相对的组织夹持元件相对于彼此定位。
夹具10可以与夹具施放器联用，下面将描述夹具施放器的一个例子，夹具施放器可以任选地具有切割元件，其在夹具10施放到组织上之间有效地切开一部分组织。
尽管夹具10可以与包括切割元件以提供组织切口的输送装置联用，但是本领域技术人员理解，切口元件可以一体地形成在夹具10的一端上，以允许夹具10在施放到组织上时切开组织。具体地说，如图1A所示，脊状部12的前缘24的一部分可以被削尖以形成切割刀片38。在使用中，在臂14、16相对于彼此岔开之后，夹具10在组织上推进，从而夹具10的切割刀片38切开组织。一旦组织被切开一定长度，可以施放臂14、16，夹具10可以回到其偏压闭合状态，以结扎切开的组织。
上述各实施例的外科夹具可以用各种装置施放到组织上。图4A-4E示出了夹具施放器装置的一个示例性实施例。如图所示，夹具施放器装置100基本上包括具有固定手柄104的壳体102、第一可动手柄或扳机106、第二可动手柄或扳机108，第一可动手柄或扳机106和第二可动手柄或扳机108均可枢转地连接到壳体102上，并通过偏压弹簧109远离固定手柄104在第一位置偏压。细长轴110从壳体102延伸并包括端部执行器，一对相对夹钳112形成在其远端以夹紧组织。细长轴110可转动地连接到壳体102上，并可包括旋钮113，用于使轴110相对于壳体102旋转。夹具施放器100包括如图4C中示例性分解示出的夹钳闭合组件116，其控制相对的夹钳112的相对定位，夹具施放器100还包括如图4D中示例性分解示出的仓组件118，其包含一个或多个外科夹具10，与夹具施放器100一起操作，将夹具10施放到组织上。下面将更详细地描述夹钳闭合组件116和仓组件118的各个部件。
图4C示例性示出了可位于夹具施放器的示例性实施例中的夹钳闭合组件116的各个部件。总的说来，夹钳闭合组件116包括细长保持器轴110，其近端连接到壳体102上，远端具有可枢转地设置的相对夹钳112。闭合管122沿着保持器轴110的长度设置，其近端通过连杆组件124连接到第一可动手柄106上，远端设置在相对夹钳112附近。在使用中，第一可动手柄106的致动使闭合管122沿着保持器轴110运动，以接近相对夹钳112使其闭合，或者岔开并从而打开夹钳112。
保持器轴110可具有各种构造。在一个示例性实施例中，保持器轴110包括沿着其长度延伸的腔126。腔126可操作，以收纳夹具推进组件118的轴部分202，从而由仓组件118运载的夹具10可以设置在相对夹钳112的附近。
尽管夹钳112可具有各种构造，但在图5A和5B中示出了其示例性实施例。如图5A所示，每个相对夹钳112可由具有连接机构136(例如销)的细长夹钳体130形成，该连接机构136可枢转地将夹钳112连接到保持器轴110上。夹钳112也可包括能够与仓组件118一起工作的多个元件，以允许夹具10施放到保持在夹钳112之间的组织上。例如每个夹钳112可包括夹具引导件137、夹具止动元件138和组织止动元件140。夹具引导件137可在夹钳112的远端132和近端134之间延伸，并且可以在夹钳112位于闭合位置时允许夹具10推进夹钳112之间。夹具止动元件138设置在夹钳112的远端132，在操作期间，可限制一个或多个夹具10从仓组件118推进超过夹钳112的远端。组织止动元件140可设置夹钳112的近端134，在操作期间，可限制或防止保持在夹钳112之间的组织进入仓组件118。夹钳112还可构造成允许切开设置在夹钳112之间的组织。例如，刀片通道142可在使用中在远端132和近端134之间延伸，其可引导切割元件从仓组件118通过夹钳112的纵向轴线，以切开设置在其间的组织。
夹钳112还包括相对的夹持表面131a、131b，夹持表面131a、131b可操作，以接触和固定其间的组织。尽管相对的夹持表面可具有各种构造，但在一个实施例中，夹持表面131a、131b可以相对于彼此成角度，以进行所需的施放。例如，如图5B所示，相对的夹持表面131a、131b可以相对于彼此成角度定位，从而夹持表面131a、131b之间的距离d沿着夹钳112的长度从远侧部分132向近侧部分136增加。在使用中，当组织夹紧在夹钳112之间时，由于形成在夹持表面131a、131b之间的角度，远侧部分132附近的组织的压缩程度大于近侧部分136附近的组织的压缩程度，由此限制组织从夹钳112的远端滑动的能力。
本领域技术人员应当理解，相对的夹钳112可以具有各种几何构造。在如图5A和5B所示的实施例中，每个相对的夹钳112具有纵向轴向146，该纵向轴线146基本上平行于细长轴110的纵向轴线148。在一个替代实施例中，如图6A和6B所示，相对的夹钳112′可以相对于细长轴110的纵向轴线形成弧形。夹钳112′的弯曲的形状和刀片通道142′的弯曲的形状可使夹具10′和切割元件(未示出)在退出仓组件118时跟随所述弧形。这样弯曲的夹钳112′可以切开组织并将夹具10′沿着弯曲路径施加到组织上。
如上所述，闭合管122可用于打开和关闭夹钳112。尽管闭合管可以具有各种构造使夹具112作这种运动，但图7示出了闭合管122的一个示例性实施例，其具有设置在夹钳112的凸轮表面152和锁闭表面154之间卷边元件150。在使用中，当闭合管122向远侧运动时，如箭头156所示，每个卷边元件150在相应的夹钳112的凸轮表面152上滑动，并且使相对的夹钳112朝向彼此旋转到闭合位置。当夹钳112向近侧运动时，如箭头158所示，卷边元件150接合夹钳112锁闭表面154，并且使相对的夹钳112远离彼此旋转到打开位置。
再次参照图4C，连杆组件124将闭合管122的近端连接到第一可动手柄106上。本领域技术人员应当理解，连杆组件124可具有各种构造。在一个示例性实施例中，如图4C和8A-8F所示，连杆组件124可以包括连接到闭合管122的近端上的闭合轭170和将闭合轭170连接到第一可动手柄106上的闭合连杆172，以及设置在闭合轭170和闭合连杆172的锁定机构176。
闭合连杆172可操作，以将第一可动手柄106的旋转运动转化成闭合轭170的线性运动。例如，闭合连杆172可通过第一销178可枢转地连接到第一可动手柄106上，并可通过第二销180可枢转地连接到闭合轭170上。在使用中，当第一可动手柄106朝固定手柄104从如图8A所示打开位置旋转到图8B所示的闭合位置时，闭合连杆172围绕销178、180转动，并使闭合轭170朝着装置100的远端运动。由于这种运动，闭合轭170将闭合管122沿着保持器轴110推进，以闭合夹钳112和夹紧其间的组织。
当夹钳112接合闭合位置，锁定机构176可固定闭合轭170和闭合管122的定位，以保持夹紧在相对的夹钳112的组织。例如，如图8C所示，锁定机构176可通过销182可枢转地连接到壳体102上，并且可包括可与闭合轭170的凹口186配合的锁闭元件182、以及将锁定机构176偏压在闭合轭170弹簧元件186。回到图8A，为了接合锁定机构176，当闭合连杆172使闭合轭170和闭合管122朝着夹钳112运动时，闭合连杆172使闭合轭170的凹口186与锁定机构176的锁闭元件184对准。由于所述对准，如图8C所示，弹簧元件188使锁定机构176围绕销182沿顺时针方向189旋转，从而锁定机构176的锁闭元件184接合闭合轭170的凹口186。因此，锁定机构176可固定闭合轭170和闭合管122在壳体102中的定位，以将相对的夹钳112固定在闭合位置，如图8D所示。
锁定机构176也可从闭合轭170脱离接合，以施放闭合轭170和闭合管122，并允许夹钳112回到打开位置。例如，锁定机构176可包括用于对锁定机构176施加扭转载荷施放杆190。如图8E和8F所示，由施放杆190沿逆时针方向施加到锁定机构176的扭转载荷使锁定机构176沿方向192旋转，并使锁闭元件与闭合轭170的凹口186脱离接合。因此，手柄106可通过弹簧109回到其停靠位置，手柄106可在壳体102内向近侧拉动闭合连杆172和闭合轭170。闭合轭170又向近侧拉动闭合管122，由此释放相对的夹钳112，并允许夹钳112回到打开位置，如图8F。
如上所示，仓组件118装纳一个或多个外科夹具10，并且与夹具施放器100一起操作，以将外科夹具10施放到组织上。图4B-4E示例性示出了仓组件118的实施例，其总体包括壳体200和从可壳体200延伸的细长轴202，该细长轴202具有在穿过其中在远端和近端之间延伸的腔210。仓组件118容纳外科夹具10、沿着轴202的长度延伸的细长切割元件或刀片238以及推进组件204，该推进组件204可操作地将刀片238和夹具10推进到夹具施放器100的夹钳112，以切开并结扎其中的组织。下面将更详细地描述仓组件118的各个部件。
壳体200能够允许将仓组件118可动地连接到夹具施放器100的壳体102上。例如，壳体200可包括将仓组件118连接到夹具施放器100的壳体102上的连接结构。具体地说，如图4A所示，壳体200包括与壳体102的锁闭元件208配合的凹口206。当仓组件118插入壳体102中时，锁闭元件208接合凹口206，以将仓组件118固定到壳体102上。当锁闭元件208从凹口206脱离接合时，仓组件118可从壳体102上拆下并去除。尽管可以各中方式将仓组件118插入壳体102，在图4B所示的实施例中，仓组件118可插入形成在夹具施放器100的近端的开口198或者从中去除。同样，当装置100的细长轴110保持在套管针或者患者中时，一个或多个仓组件118可以插入装置100或从中去除。
细长轴202可以插入保持轴110的腔126，从而细长轴202的远端设置在相对的夹钳112附近。细长轴202还可具有设置在细长轴腔210中的一个或多个夹具10和刀片238，以输送到装置100的相对的夹钳112。
本领域技术人员应当理解，夹具供应器及其夹具10可以各种方式设置在轴腔210内。例如，多个夹具供应器可以端对端地对准，从而每个夹具10的纵向轴向基本上与细长轴202的纵向轴线平行。在另一个例子中，如图4C所示，夹具供应器可以沿着腔210的长度成对布置在刀片238的两侧，从而相对的夹具供应器的脊状部12面对彼此。在这种尤其对横切有利的布置中，当刀片238将夹钳112之间的组织切开成两个分离的组织部分时，成对的夹具施放器可以基本上同时施放到分离的组织部分上。尽管图4C示例性示出的细长轴202包括三对夹具供应器，本领域技术人员应当理解，可以将任意数量的夹具或夹具供应器设置在轴腔210中。
本领域技术人员应当进一步理解，夹具供应器的夹具可以在闭合或打开状态存储到细长轴202的腔210中。由如弹簧钢的弹簧材料制成的夹具可以在闭合位置存储在腔210中，以保持夹具的弹簧性质，并在施放到组织上之前将臂14、16的过度变形最小化。另外，由如镍钛诺的超弹性材料制成的夹具可以在打开位置存储在腔210中。但是，不管在哪种情况下，在将夹具输送到组织以施放到其上之前，夹具应该打开，以允许夹具10的臂14、16放置在待结扎的组织两侧。这样，仓组件118可以包括夹具打开机构220，其在夹具输送到组织时将夹具保持在打开状态。
图9A-9E示例性示出了夹具打开机构220的一个实施例，其可操作，以将夹具的臂14、16从偏压的闭合位置扩张到打开位置，由此允许夹具10施放到组织上。如图9B所示，夹具打开机构220在夹具施放器的相对的夹钳的附近连接到细长轴202的远端上，夹具打开机构220包括楔形部分222和细长部分224。在使用中，如图9C所示，设置在细长轴202中的处于闭合位置的夹具10c被沿着方向226推向夹具打开机构220的楔形部分222。如图9D所示，当夹具10c沿着方向226运动时，楔形部分222插在夹具10c的第一端部28处的臂14b、16b之间，以使臂14b、16b分开。当夹具10c进一步沿着方向226运动时，楔形部分222继续将夹具10c的臂14b、16b分开，直到夹具10c到达细长部分224，如图9E所示。当夹具10c继续沿着方向226朝相对的夹钳112运动时，细长部分224将臂14b、16b保持在分开的关系。当夹具10c进入装置100的夹钳112时，臂14b、16b可以设置在由夹钳112夹紧的组织两侧上。当夹具10c离开细长部分224时，如图9E中夹具10a所示，臂14b、16b回到偏压的闭合状态，以接合其间的组织。
尽管图9C-9E示例性示出了使用单个夹具打开机构220，本领域技术人员理解，细长轴202可以包括任何数量的夹具打开机构。例如，如图9A所示，细长轴202包括是设置在刀片238两侧上的第一和第二夹具打开机构220a、220b。在使用中，每个夹具打开机构220a、220b打开一对相对的夹具的相应的夹具10a、10b，由此允许将每个打开的夹具输送到夹具施放器的夹钳中的相应的分开的组织部分。
图10A-10B示例性示出了另一个实施例夹具打开机构220′，其可操作，以在夹具10输送到组织之前将夹具10在打开位置保持在细长轴202中。例如，夹具打开机构220′可包括第一和第二臂延伸部分230、232。当插在夹具10的臂14、16之间时，第一和第二臂延伸部分230、232迫使臂14、16相互分开，并且将臂14、16保持在分开的关系。在一个实施例中，夹具打开机构220′连接到推进组件204上，从而当推进组件204将夹具10移入相对的夹钳112中时，夹具打开机构220′可沿着细长轴202的纵向轴线与夹具10一起平移。在这种构造中，夹具打开机构220′可将夹具10的臂14、16保持在打开位置，同时夹具10插入相对的夹钳112中。一旦夹具10插入相对的夹钳112中，推进组件204可使夹具打开机构220′从夹具10缩回，如图10B所示，以允许臂14、16回到其偏压的闭合位置，并且结扎保持在相对的夹钳112中且位于夹具10的通道17中的组织。
回到图4A-4E，如上所述，推进组件204与夹具施放器100一起操作，以将刀片238和夹具10推进到夹具施放器100的相对的夹钳112中，从而切开并结扎其间的组织。如图4D和4E所示，推进组件204的一个示例性实施例包括推进器240，其具有一个或多个推杆252和连接到其上的刀片238。推进器240可滑动地设置在细长轴202的位于第一和第二壁244、246之间的部分242上，弹簧248可设置在推进器240和第一壁244之间，以朝着处于停靠状态的仓118的近端偏压推进器240。推进器240还连接到第二可动手柄108上，从而在使用中当第二可动手柄108朝着固定手柄102旋转以克服由弹簧施加在推进器240上的力时，手柄108使推进器240朝着仓118的远端运动。由于这种运动，推进器240使刀片238从细长轴202中的回缩位置运动到相对的夹钳112中的展开位置，并且使推杆252将一个或多个夹具从仓118的远端分配到相对的夹钳112，由此切开并结扎夹紧在其间的组织。
尽管本领域技术人员理解，推进器240可以各种方式连接到第二可动手柄108上，但是在一个示例性实施例中，推进器240可包括推块249，其允许选择地连接第二可动手柄108和推进器240。在使用中，如图8B所示，当第一可动手柄106朝着固定手柄104转动以闭合相对的夹钳112时，其也使第二可动手柄108相对于固定手柄104转动，从而推块连接元件254(例如钧元件)接合推块249的突起252。当第二可动手柄108朝着固定手柄104转动时，如图11所示，突起252在推块连接元件254的狭槽256内运行，因此使推块249和推进器240朝着仓118的远端运动，并压缩弹簧248。相反，当第二可动手柄108从固定手柄104释放时，弹簧248可扩张，使推进器240和推块249向近侧运动，从而使推进器240和推块249回到壳体200中的停靠状态。
本领域技术人员理解，推块249可以各种方式连接到推进器上。例如，回到图4D和4E，推块249可以插入形成在夹具推进器的外表面中的环形沟槽中。在这种构造中，推块249允许细长轴202和推进器240在仓壳体200中旋转，同时保持推进器240和第二可动手柄108之间的连接。
推杆252可在细长轴202中延伸，并且包括设置在一个或多个夹具10附近的远端和连接到推进器240上的近端。尽管推杆252的近端可以各种方式连接到推进器240上，但在一个实施例中，推杆252连接到与推进器240相连的棘轮组件250上，允许推杆252在细长轴202中推进，从而以连续的方式展开其中的夹具10。例如，如图12A所示，推杆252可包括推进器凹口274a-274c，它们选择地与图12C所示的棘轮组件250的推进器棘轮270连接。推杆252还包括制动器凹口276a-276c，它们选择地与图12C所示的棘轮组件250的制动器棘轮272连接。回到图4E，推进器棘轮270连接到推进器240上并且包括棘轮柄278和弹簧元件282，弹簧元件282将柄278朝推杆252偏压。推进器棘轮270可操作，以连续地接合推杆252的推进器凹口274a-274c中的每一个，以朝着仓组件118的远端推动推杆252。制动器棘轮272固定到仓壳体200上并且包括棘轮柄280和弹簧元件284，弹簧元件284将柄280朝推杆252偏压。制动器棘轮272可操作，以连续地接合推杆中的制动器凹口276a-276c中的每一个，以限制或防止推杆252向近侧运动，同时将夹具10施放到组织上。
下面描述棘轮组件250的使用，以通过夹具施放器100提供一系列夹具的连续展开。在图9B所示的一个实施例中，细长轴202其中包括三个夹具10a、10c和10e。在停靠状态，在展开之前，最远侧的夹具10a定位在夹具打开机构220附近，最近侧夹具10e定位在推杆252远端附近。另外，在停靠状态，如图8B所示，推杆252的近端连接到棘轮机构250上，从而推进器棘轮270的柄278设置在推杆252的第一推进器凹口274a内，制动器棘轮272设置在推杆252的第一制动器凹口276a内。
在第一可动手柄106在第一击发过程期间朝着固定手柄104旋转以致动夹钳闭合组件116之后，第二可动手柄108可如图11所示朝着固定手柄104转动，使得推进器240将推进器棘轮270拉向仓118的远端。通过这种运动，推进器240将刀片238从仓118的远端伸入相对的夹钳112中，并使推进器棘轮270将推杆252朝着仓118的远端推进。这样，推杆252接触近侧夹具10e，并且推进夹具组10a、10c、10e，从而远侧夹具10a如图9C和9D接合夹具打开机构220。推杆252进一步朝远侧的运动将夹具10a推进到相对的夹钳112中，使制动器棘轮272的柄280接合推杆252的第二制动器凹口276b，如图12C所示。在夹具10a输送到相对的夹钳12之后，第二夹具10c保持设置在夹具打开机构220上。
当第二可动手柄108释放时，推进器240将刀片238从相对的夹钳12缩回。但是，如图12B所示，由于这种缩回，刀片238的远端定位在第二夹具10c之后。为了确保刀片238的切割刃在随后的击发过程中定位在第二夹具10c之前，由此允许夹紧在夹钳112之间的组织在输送夹具10c之前切开，当第二可动手柄108释放时，推进器240使推进器棘轮270在壳体200内向近侧运动，从而推进器棘轮270的柄278靠在推杆256上，与第二推进器凹口274b距离d。这样，在第二击发过程中，当第二可动手柄108朝着固定手柄104转动时，推进器240沿方向279并沿着距离d拉动推进器棘轮270，同时使刀片238向远侧运动。当推进器棘轮270被沿着推杆256的距离d拉动时，推进器棘轮270不会使推杆256推动夹具10c、10e。相反，当推进器棘轮270沿着距离d运行时，推进器240使刀片238与最远侧的夹具10c对准，从而刀片238的远端定位在夹具10c之前。当推进器棘轮270的柄278接合第二推进器凹口274b时，刀片238的切割刃定位在夹具10c之前。推进器240进一步向远侧的运动使刀片238和推杆256运动，从而刀片238和夹具10c一起推进。在夹具10c从装置展开之后，该过程可以重复，以展开近侧夹具10e，在近侧夹具10e展开之后，所推杆256的锁定机构290如图12B所示可接合夹具打开机构220，以防止推杆256被推进经过仓118的远端进入夹具施放器100的相对的夹钳12。
图13A-13D示例性示出了夹具施放器100的一个实施例，其用于切开和结扎组织，例如脉管300。在图13A中，夹具施放器100的相对的夹钳12设置在待结扎的脉管300的附近并运动到打开位置。例如，夹具施放器100的细长轴可插入植入患者体内的套管针的插管中，并在其中推进到脉管300的位置。脉管300可设置在相对的夹钳12之间直到脉管到达组织止动件140。在图13B中，相对的夹钳12闭合到脉管上，以压缩和密封脉管。可以例如如下过程进行所述闭合：朝着固定手柄104旋转夹具施放器100的第一可动手柄106，使夹钳闭合组件116致动并使夹钳112从打开位置运动到闭合位置。
在图13C中，设置在夹钳112之间的脉管300被切开，夹具被推进到切开的组织部分上。例如，夹具施放器100的第二可动手柄108可以朝着固定手柄104旋转，以将夹具从偏压的闭合位置定位到打开位置。手柄108的进一步的旋转使切割元件238推进到夹钳112的刀片通道142中，由此切开脉管300并形成脉管部分300a、300b。打开的夹具可以随后被推进到切割元件238后的闭合夹钳112的夹具引导件137中，从而脉管部分300a设置在夹具10a的臂14a、16b之间，脉管部分300b设置在另一个夹具10b的臂14b、16b之间。在这个过程中，旋转第二可动手柄108以将夹具10a、10b展开到脉管中所需的力(例如“击发力”)较低，可以在大约3磅力-5磅力的范围内。在图13D中，夹具10a、10b从夹具施放器100释放，并且可以回到偏压的闭合位置，以结扎脉管部分300a、300b。
本领域技术人员将根据上述实施例理解本发明的其他特征和优点。因此，本发明不由所具体描述和显示的所限制，除非由后附权利要求书所指明。所有引用的文献通过引用全部内容并入本文。

Claims (10)

1.一种外科夹具，包括：
脊状部，具有由顶部边缘和顶部边缘限定的高度，并且沿着夹具的纵向轴线从第一夹具端部到第二夹具端部延伸；以及
相对的臂，从所述脊状部顶部边缘和顶部边缘延伸，所述臂被偏压到闭合位置，从而相对的臂中的每一个的端部彼此相邻，以限定组织夹紧区域，所述组织夹紧区域具有由所述臂限定的夹紧长度。
2.如权利要求1所述的外科夹具，其特征为，所述外科夹具沿着所述长度在一个或多个位置易折断，从而可选择地控制所述组织夹紧区域的长度。
3.如权利要求1所述的外科夹具，其特征为，所述夹具的脊状部可沿着纵向弯曲，从而可选择地改变所述夹具的形状。
4.如权利要求1所述的外科夹具，其特征为，每个相对的臂包括沿着夹具的长度设置的一个或多个狭槽，每个狭槽从每个相对的臂的端部朝着脊状部沿基本上垂直于夹具的纵向轴线的方向延伸。
5.如权利要求4所述的外科夹具，其特征为，每个狭槽终止于与脊状部相邻的位置。
6.如权利要求1所述的外科夹具，其特征为，相对的臂的端部包括适于将夹具固定到组织上的组织夹持元件。
7.如权利要求6所述的外科夹具，其特征为，第一臂的组织夹持元件可相对于相对的第二臂的组织夹持元件沿着所述长度摆动。
8.如权利要求1所述的外科夹具，其特征为，切开元件一体地形成在第一夹具端部和第二夹具端部中的一个上。
9.如权利要求1所述的外科夹具，其特征为，所述组织夹紧区域的长度大于所述脊状部的长度。
10.如权利要求1所述的外科夹具，其特征为，每个相对的臂相对于脊状部成锐角定向。
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CA2568577C (en) 2016-01-05
US20150080915A1 (en) 2015-03-19
CA2568577A1 (en) 2007-05-23
US8915931B2 (en) 2014-12-23
AU2006236074A1 (en) 2007-06-07
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JP5073274B2 (ja) 2012-11-14
JP2007144169A (ja) 2007-06-14
EP1813214A1 (en) 2007-08-01
MXPA06013576A (es) 2008-10-15
AU2006236074B2 (en) 2012-12-13
CN1969769B (zh) 2010-11-17
BRPI0604930B1 (pt) 2018-02-14
US20070118163A1 (en) 2007-05-24
US7896895B2 (en) 2011-03-01
ATE476922T1 (de) 2010-08-15
US10105144B2 (en) 2018-10-23
US20110137324A1 (en) 2011-06-09

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