CN103181808A - 手术吻合和切割装置及其使用方法 - Google Patents
手术吻合和切割装置及其使用方法 Download PDFInfo
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Abstract
一种医疗装置包括具有铰接接头起动器的控制手柄、手术端部执行器和将端部执行器与控制手柄相连接的被动铰接接头。被动铰接接头起动器在不起动时保持被动铰接接头不动,因此保持端部执行器在充分固定位置,铰接接头起动器在起动时松开被动铰接接头,使其处于自由铰接状态,允许端部执行器根据作用于端部执行器的外力,响应控制手柄作自由铰接活动。操作端部执行器的方法包括用铰接锁将被动铰接接头保持在固定位置和松开铰接锁,使被动铰接接头解锁,从而允许端部执行器根据其受到的外力,通过被动铰接接头作铰接活动。
Description
本申请是申请号为200680035337.X、申请日为2006年7月25日的中国专利申请的分案申请。
技术领域
本发明属于医疗装置领域,具体说是属于手术吻合器械领域,它能够将成列的缝合钉钉入到身体组织,同时切割成列的这些缝合钉之间的组织,更具体地涉及有关吻合器器械的改进和形成包括一根铰接轴的这种吻合器的各种部件的方法的改进。这种装置尤其适用于在内窥镜或腹腔镜手术过程中吻合和切割组织。
背景技术
经常愿意用内窥镜外科手术器械代替传统的开放式手术装置,因为较小的切口往往缩短术后恢复时间和减少并发症。因此,已经开发出一系列适合于将远端执行器通过套管针的套管准确放置于所希望的手术部位的内窥镜手术器械。这些远端执行器以几种方法进入组织,达到诊断或治疗效果(例如内切割器、抓钳、切割器、吻合器、施夹器、接近装置、药物/基因治疗输送装置和使用超声波、射频、激光等的能量装置)。
放置端部执行器受套管针的约束。通常这些内窥镜手术器械在端部执行器与手柄部分之间有一根由医师操作的长轴。这根长轴能够插入到所要求的深度和绕该长轴的轴线旋转,从而将端部执行器放置到一定程度。恰当的放置套管针和使用抓钳,例如通过另一个套管针,这个放置量经常是足够的。手术吻合和切开器械,例如在授权给Knodel等人的5,465,895号美国专利中所描述的,是一个通过插入和旋转成功地放置端部执行器的内窥镜手术器械的例子。
由美国外科手术公司制造和在授权给Dreen等人的6,644,532号和6,250,532号美国专利中描述的一种吻合器有一个端部执行器,它沿一个平面根据一根杆的推动分步骤绕枢轴运动,这根杆对应地沿一个平面以相同的步骤运动。见图31和32。但是美国外科手术公司的吻合器受它能够获得的预定的角度和需要两只手操作的、受限的左右转动(-45度到+45度)的限制。
根据手术的特点,可能需要进一步调整内窥镜手术器械端部执行器的定位,而不仅仅是局限于插入和转动。尤其是经常希望使端部执行器在与器械轴的纵向轴线成横向的轴线上定位。端部执行器相对于器械轴的横向运动通常叫做“铰接运动”。这种铰接定位在某些情况下使医师更容易进入组织。另外,铰接定位能方便地将内窥镜放置到端部执行器后面,而不被器械轴阻隔。
尽管上述非铰接式吻合和切割器械很有用,可以成功地用于许多手术操作,但仍然希望通过端部执行器的铰接活动来改进操作,使得在临床使用时获得更大灵活性。铰接手术器械通常使用一根或几根在器械轴内沿纵向运动的击发杆,通过铰接接头从钉仓内击发缝合钉和切割最里面的缝合钉行列之间的组织。这种手术器械一个共同的问题是通过铰接接头控制击发杆。在铰接接头,端部执行器在纵向与轴有间隔,因此在铰接活动时轴和端部执行器的边缘不会碰撞。这个间隙必须用支承材料或结构填充,防止一根或多根击发杆在受到纵向击发负荷时因折损从铰接接头翘曲。需要有一个支承结构通过铰接接头引导和支承一根或多根击发杆和随着端部执行器的铰接活动而弯曲。
授权给Schulze等人的5,673,840号美国专利描述了一种用弹性体或塑料形成的柔性铰接接头,它在柔性接头或“弯颈”弯曲。由弯颈内的空心管引导和支承击发杆。弯颈是钳颚闭合机构的一部分,当钳颚在组织上闭合时,弯颈相对于端部执行器、轴和击发杆作纵向移动。因此当击发缝合钉和切割组织时,击发杆那么在弯颈内纵向移动。
授权给Oberlin等人的5,797,537号美国专利(所有权属于Richard-Allan医疗器械公司)描述了一种绕一根销子作枢轴转动而非沿弯颈弯曲的铰接接头。在这种器械中,击发杆支承在一对隔开的支承板之间,所述支撑板的一端与轴连接,另一端与端部执行器连接。这两个连接至少有一个是滑动连接。支承板通过与柔性驱动杆相邻的铰接接头在铰接平面内延伸,使得当击发杆的端部从对正位置向一个方向作铰接运动时,支承板通过间隙在铰接平面内弯曲,柔性击发杆克服支承而弯曲。授权于美国外科医疗器械公司的Milliman等人的6,330,965号专利教授使用支承板,这种支承板与轴固定地连接和可滑动地连接到端部执行器。
虽然这些已经知道的支承板能通过铰接接头引导击发杆,但是认为可以改进其功能。比如经常希望击发杆在击发过程快速加速,以保证有效地切割组织所需要的足够的动量。刚性连接的支承板可能失去响应性,使击发杆从铰接接头弹出。另一个例子是希望不论器械是否是铰接的,都能用同样的方式操作。
在用铰接式接头时,如果要求施加大小不同的击发力,增加的摩擦力给医师造成不方便和使其感到麻烦。
因此,非常需要改进手术器械的铰接机构,使其通过铰接接头对击发杆提供增强的支承。
发明内容
因此,本发明的目的是提供一种手术吻合和切割装置和使用这种装置的方法,它们能够克服至今所知道的普通型式的装置和方法的上述缺点,和提供一种铰接式手术端部执行器。
根据上述和其它目的,本发明提供一种医疗装置端部执行器连接组装件,包括一个连接端部执行器和控制手柄的被动铰接接头。
根据本发明的目的,在具有连接到控制手柄的端部执行器的医疗装置中,还提供一个包括被动铰接接头的端部执行器连接组装件,该被动铰接接头连接端部执行器和控制手柄。
根据本发明的目的,还提供一种医疗装置,其包括控制手柄和通过被动铰接接头连接到控制手柄的手术端部执行器。
根据本发明的目的,还提供一种医疗装置,其包括控制手柄和与控制手柄被动铰接连接的手术端部执行器。
根据本发明的目的,还提供一种医疗装置,其中包括具有被动铰接接头的第一部分的控制手柄和具有被动铰接接头的第二部分的手术端部执行器,被动铰接接头的第一和第二两部分将端部执行器连接到控制手柄。
根据本发明的目的,还提供一种医疗装置,其中包括控制手柄和手术端部执行器,该手术端部执行器具有连接端部执行器和控制手柄的被动铰接接头。
根据本发明的目的,还提供一种医疗装置,包括控制手柄、手术端部执行器和连接端部执行器与控制手柄的被动绞接接头。
根据本发明的目的,还提供一种医疗装置,其中包括具有铰接接头起动器的控制手柄、手术端部执行器和将端部执行器与控制手柄相连接的被动铰接接头。铰接接头起动器有未起动状态和起动状态。当铰接接头起动器处于未起动状态时,保持住被动铰接接头,从而使端部执行器处于充分固定的绞接位置;当铰接接头起动器处于起动状态时,松开被动铰接接头,使其处于自由铰接状态,允许端部执行器根据作用于端部执行器的外力相应于控制手柄作自由铰接活动。
根据本发明的目的,还提供一种医疗装置,其包括:具有带缝合钉的吻合装置和带刀片的切割装置中的至少一个的手术吻合端部执行器;具有在起动时关闭吻合器的吻合器闭合起动器的控制手柄;缝合钉击发起动器,当起动时,其完成用缝合钉进行吻合和用切割装置切割组织中的至少一种;具有未起动状态和起动状态的绞接接头起动器;以及连接端部执行器和控制手柄的被动铰接接头。当起动铰接接头起动器时,端部执行器根据作用到端部执行器上的外力作自由铰接活动,当未起动铰接接头起动器时,端部执行器锁定在给定的铰接位置。
在本发明的一个方面,外科手术器械有一个手柄部分,它松开铰接锁,使端部执行器作铰接活动和在绞接的同时击发。解锁和击发机构通过轴传递到铰接机构。铰接机构响应使用者给与端部执行器的力,使端部执行器作铰接活动,与轴的纵向轴线不成直线。击发机构响应击发运动,通过铰接机构和端部执行器实现运动偶联。击发支承装置支承击发机构和在发生铰接运动时使击发机构保持在适当位置。
根据本发明另一个的特点,控制手柄有铰接接头起动器,起动器有未起动状态和起动状态;端部执行器有铰接锁,铰接锁有铰接锁定状态和铰接解锁状态,当铰接接头起动器从未起动状态改变为起动状态时,铰接锁从锁定状态改变为解锁状态;当铰接接头起动器从起动状态改变为未起动状态时,铰接锁从解锁状态改变为锁定状态。
根据本发明进一步的特点,吻合器闭合起动器和缝合钉击发起动器与铰接接头起动器不同。
根据本发明附加的特点,至少提供一根第一柔性梁,用于将控制手柄通过被动铰接接头连接到缝合钉击发起动器;至少提供一根第二柔性梁,用于将端部执行器通过被动铰接接头纵向连接到控制手柄。第一和第二柔性梁以对应于被动铰接接头的铰接活动的方式弯曲。
根据本发明附加的特点,控制手柄有第一纵向轴线,端部执行器有第二纵向轴线,控制手柄、端部执行器和被动铰接接头三者中至少有一个有对正装置。在一项典型的实施方式中,当铰接接头起动器被起动时,对正装置使端部执行器偏离,基本上对正第一条纵向轴线和纵座标轴。对正装置可以是中心偏离装置。在这种实施方式中,中心偏离装置是装在第一纵向轴线的对侧的一组弹簧承载的柱塞,独立地推动端部执行器,使第二纵向轴线与第一纵向轴线对正。
本发明的另一个优点是可活动的远端执行器是中心偏置的。这意味着远端执行器首先从一个固定位置被松开,然后通过推压端部执行器而抵住周围结构,例如周围的组织,远端执行器被动地移动到新的位置。当使端部执行器解除固定位置的起动器被松放时,远端执行器在中心偏置装置的推动下回到中心位置,至少有一个(最好有两个)偏置弹簧在相反方向(因此是居中方向)给与偏置力。或者,中心偏置装置可以是装在端部执行器任一侧的U形座上的一组弹簧承载的柱塞,独立地推动端部执行器回到中心位置。
又根据本发明的另一个特点,铰接接头起动器具有带指向远端的齿的拉动锁,被动铰接接头具有带指向近端的齿的齿轮,当铰接接头起动器未起动时,铰接接头起动器指向远端的齿与被动铰接接头齿轮指向近端的齿互锁;当铰接接头起动器起动时,铰接接头起动器指向远端的齿与被动铰接接头齿轮指向近端的齿脱离,使端部执行器能够作铰接活动。
又根据本发明的另一个特点,远端运动的操作是通过拉动-释放和松开—再锁定扳机实现的。控制被动运动的扳机通常是锁死的。该锁通过拉动扳机松开。一旦远端执行器处于所要求的位置,使用者松开扳机,从而将端部执行器锁定在新位置。
本发明的装置是手术吻合器和切割器或可用于其它内窥镜装置,尤其适用于将组织的几个部分吻合在一起和在需要时切割组织。在一种端部执行器的实施方式中,执行吻合和切割功能的两种手段可以完全包括在该装置的端部执行器内。
本发明还有一个优点是控制手柄是电子控制的、通用的和机动化的。控制手柄包括一个为多种产品构型编程的微处理器。例如,在作为吻合器时,控制手柄被设计用于30mm、45mm和60mm缝合钉仓。吻合器的远端轴有一个插入通用手柄的近端。远端轴包括一列电控接触器,与手柄连接位置的配合列对应接触。每根不同的远端轴的接触器是独特的,手柄“识别”轴和运行适于它的程序。手柄编程包括安全锁闭、吻合器输送速度、行程距离等逻辑电路。这种模块化允许制造一个手柄具有多个端部执行器。
操作该装置用电动马达完成。该装置也可以用多个电动马达、液压或气动操作,或者通过柔性传动轴以任何方式传递能量,使得操作组装件可以主要或全部包括在该装置的远端部分。
由上述任何一种方法完成的工作可以通过螺杆传动、齿轮传动、楔形块、肘节、凸轮、皮带、滑轮、绳索、轴承或类似推杆中的任何一种或组合转换成所要求的动作。尤其是用螺杆传动将电动马达做的功转换成直线运动。在一种实施方式中,驱动螺杆的马达装在手柄内。柔性转动绳索连接马达和螺纹轴。因此,当马达以任一方向转动时,柔性绳索的转动传到螺纹传动轴,由于缝合钉击发器和切割滑块装在传动轴上,因此两种功能都是由滑动的远端移动完成的。在第二种实施方式中,整个马达装在端部执行器内,并且具有直接或通过变速齿轮联接滑动传动轴的轴。在这种情况下,控制手柄需要完成的只是控制开/关起动器和传动轴旋转方向起动器,前者为起动或停止马达,后者决定马达转动方向。
该装置有一个用螺杆驱动装置传动的钉仓,用于完成多种功能,其中包括闭合吻合器钳颚、推动切割刀片和击发缝合钉。钉仓不是完成这些任务唯一的方法。第二或多工作机构可以提供完成任何功能所必须的工作。
在端部执行器的第二种实施方式中,整个吻合和切割操作装置装是独立的和位于活动接头的远端。整个操作装置可以插装和由多轴线“球”或“万向”接头操纵,这样就能够根据操作人员的意愿完成任何运动和限制。另外,整个操作装置可以不受控制手柄控制,而从不同角度重新抓握,使位置更灵活。
根据本发明另外的特点,被动铰接接头是球形接头,有一个球、球铰碗以及将球和球绞碗互相锁定和解锁的球杯锁定装置,当控制手柄处于未起动状态时,球杯锁定装置处于锁定状态;当控制手柄处于起动状态时,球杯锁定装置处于解锁状态。端部执行器有球和球绞碗装置中的一个,控制手柄有球和球绞碗装置中的另外一个。球与球绞碗装置是可拆式联接。
根据本发明另外的特点,端部执行器有两个纵向端部,球为两个球。每个纵向端部有一个球,每个球与球绞碗装置是可拆式联接。
在一方面,该器械用纵向传动的击发机构起动端部执行器,击发机构有利地用侧面支承板或刚性支承通道通过铰接机构支承住。在前一实施方式中,为了更好地响应击发机构的击发负荷,每一块支承板的一端或几端弹性地连接到铰接机构的一侧,这样能更好地避免击发机构的翘曲。例如,一对支承板越过铰接机构从侧面支承击发机构,每块支承板包括弹性连接到铰接机构内形成的框形凹口内的端部,这有助于防止击发机构在铰接机构内弯曲或从铰接机构中翘曲出来。
在通道实施方式中,通道在铰接机构内浮动,当向任何方向作铰接运动时,其具有支承击发机构的表面,从而避免击发机构翘曲。通道有底板和两个侧面。支承通道自由地安置在铰接机构内腔中。通道端部是弯曲的,与内腔的弯曲匹配。当击发机构在铰接机构内弯曲时,支承通道具有不同的内表面接触和支承击发机构,因此有助于避免击发机构在铰接机构内翘曲或从铰接机构内翘出。
因此,不同型式的诊断或治疗驱动端部执行器可以组合到本发明的铰接手术器械中,即使在高击发力时也不会在铰接机构内翘曲,并且减小了内窥镜用途的部件尺寸。
在本发明的另一方面,手术器械有产生闭合动作、击发动作、铰接机构解锁动作和铰接动作的控制手柄部分,每一种动作通过一根轴传递。端部执行器包括一条与轴耦合的长通道,用于接受缝合钉或钉仓和抵钉座,抵钉座用枢轴与长通道联接,响应来自轴的闭合动作。击发装置有一个以纵向装在长通道和抵钉座之间的远端刀刃刃。击发装置从控制手柄通过轴和铰接机构连接到端部执行器。击发装置用击发动作进行吻合和切割。铰接机构允许端部执行器相对于轴移动。铰接机构的远端与轴联接,在解除铰接锁(即解锁)后允许端部执行器作铰接活动,响应作用到端部执行器的力,产生铰接活动。换言之,当铰接锁被解锁时,端部执行器对周围的压力将导致端部执行器相对于轴作铰接活动。为了支承击发机构,一对支承板越过铰接机构从侧面支承击发机构,每块支承板包括弹性连接到铰接机构内形成的框形凹口内的端部,或者刚性通道可以穿过绞接机构包围击发机构。因此,改进的吻合和切割器械可以组合一个能承受高击发负荷的击发机构,而不会在作铰接活动时显著增大击发力的击发装置。
起动装置可以制造成不同长度和/或制造成直径适合于腹腔镜或内窥镜的使用、或者两者都适合。可以使用可更换的缝合钉钉仓。起动装置同样可以连接到一个柔性内窥镜的远端。
本发明的一个显著优点是端部执行器的动作是被动的和可锁定的。换言之,端部执行器能够解锁,可靠地活动到所要求的位置,然后使其保持在新位置-全部动作用一只手操作。内窥镜和腹腔镜手术要求医生能独立使用两只手。没有这一条要求将使这种手术特别困难或不可能进行。本发明的控制手柄可以执行松开/锁定动作而无须使用第二只手,使本装置能够真正一只手操作。
本发明另外一个优点是端部执行器的轴向移动是独立的和手动的。例如,使用者在插入器械之前,可以绕装置的纵向轴线转动远端执行器而设定轴向移动。通过从轴上向外拉端部执行器,然后向要求的方向拧转端部执行器完成预先设定位置。这种轴向移动结合离轴移动(从一侧向另一侧)在远端形成一个复合角,帮助精确定位端部执行器(或甚至多个端部执行器)。在另一种变型中,使用者通过提供一个转动装置,这个转动装置轴向固定地但是自由转动地将控制手柄联接到包括轴、铰接机构和端部执行器的远端部件,从而可以在任何时间动态地绕装置的纵向轴线转动远端执行器。远端部件的转动是通过向离开端部执行器的方向拉动钟形转动装置、然后绕轴的纵向轴线向要求的方向旋转转动装置来实现的。这个转动运动与端部执行器的离轴移动结合,在装置的远端形成一个复合角度,帮助精确地定位端部执行器(或甚至多个端部执行器)。
本发明还有一个优点是吻合器/切割器可以被设计成安装在一个标准的柔性内窥镜的端部。对装置的控制通过内窥镜的工作通道反馈并与控制手柄或控制模块配合。
根据本发明的目的,还提供了一种操作医疗装置端部执行器的方法,包括用绞接锁保持控制端部执行器的铰接活动的被动铰接接头在稳定位置的步骤,以及起动铰接锁松开,使被动铰接接头解锁,允许端部执行器根据作用到其上的外力通过被动铰接接头作铰接活动的步骤。
根据本发明的目的,还提供了一种操作医疗装置端部执行器的方法,包括用铰接锁将被动铰接接头保持在锁定状态的步骤以及起动铰接锁,以便将被动铰接接头解锁,允许被动铰接接头根据作用到端部执行器上的外力作铰接活动的步骤。
根据本发明的另一种模式,端部执行器被动地活动到铰接位置。
根据本发明的又一模式,通过将端部执行器的一部分压向周围结构,使端部执行器被动地活动到铰接位置。
根据本发明的一个附加模式,在端部执行器施加一个力,使端部执行器作铰接运动,进入所要求的铰接位置。
根据本发明另一种模式,取消铰接锁的起动,将被动铰接接头锁定,从而防止端部执行器继续作铰接活动。
所有上述步骤能有利地用一只手完成。
被认为是本发明的特点的其它特征列在所附权利要求中。
虽然本发明解释和描述了一种外科手术吻合和切割装置和使用这种装置的方法,但本发明不局限于所给出的细节,因为在不偏离本发明的精神和在权利要求相同的范围内可能对此进行各种改型和结构改变。
结合附图阅读下列具体实施方式的描述,将会最好地理解本发明的构造和操作方法以及其它目的和优点。附图说明
本发明实施方式的优点将在下面优选实施方式的详细说明中得到显现,应当结合以下附图考虑这些描述:
图1是根据本发明的远端吻合和切割端部执行器和所连接的轴的一部分从远端看的放大的局部立体图,其中缝合钉仓从端部执行器的钉仓钳颚大约拉出一半,吻合器的抵钉座与缝合钉击发和组织切割滑块分开;
图2是图1所示的端部执行器放大的局部侧视图,带有远端罩,近端堞形(castellation)轴向运动零件,为清楚起见而卸掉的钉仓,与滑板连接的吻合器的抵钉座;
图3是图1所示的端部执行器放大的局部立体图,在远端带有缝合钉击发和组织切割滑块,但具有与滑块分离的吻合器的抵钉座;
图4是图1所示的端部执行器放大的局部立体图,缝合钉仓已从下钳颚/缝合钉仓保持器卸下,U形叉相对于中心转动大约45度角。
图5是图1所示的端部执行器的远端部分的局部放大侧视框架图;
图6是图1所示的端部执行器的堞形轴向运动组装件旋转大约90度的框架立体图,为清楚起见,端部执行器的横向运动锁销和近端螺栓已卸下;
图7是图6所示的端部执行器从底部看的局部放大立体框架图,端部执行器横向运动锁销与横向运动链轮齿接合,为清楚起见弹簧和近端螺栓已卸下;
图8是图7所示的端部执行器局部放大的底部平面框架图,端部执行器横向运动锁销与横向运动链轮齿接合;
图9是图8所示的端部执行器从底面看的局部放大的纵剖面图,端部执行器横向运动锁销与横向运动链轮齿接合,为清楚起见弹簧已卸下;
图10是图2所示的端部执行器绕纵向轴线旋转后放大的局部立体图,为清楚起见,已将U形叉、螺栓、远端轴向运动堞形套和弹簧部件卸下;
图11是图1所示的端部执行器的远端部分的局部放大的底面平面图,缝合钉击发和组织切割滑块在近端位置;
图12是图11所示的端部执行器的远端部分的局部放大的底面平面图,缝合钉击发和组织切割滑块在中间位置;
图13是通过图2所示的端部执行器的缝合钉击发和组织切割滑块的局部放大的径向剖面图;
图14是通过图1所示的端部执行器下半部分的局部放大的水平纵剖面图;
图15是通过图1所示的端部执行器的近端上半部分的局部放大的水平纵剖面图;
图16是通过图1所示的端部执行器的近端部分的纵向轴线的局部放大的垂直纵剖面图;
图17是通过图1所示的端部执行器的近端右半部分的局部放大的垂直纵剖面图;
图18是根据本发明的手术吻合器左侧面图,其中端部执行器钳颚在控制手柄的静止位置下张开;
图19是图18所示的手术吻合器左侧面图,其中端部执行器的钳颚在控制手柄的拇指扳机的起动位置下闭合;
图20是图18所示的手术吻合器从上看的左侧面图,横向运动扳机压下;横向自由运动状态的远端执行器取决于与周围环境如表面的接触;端部执行器钳颚在控制手柄的静止位置下张开并处于侧向大约45度角度;
图21是图18所示的手术吻合器从上看的左侧面图,横向运动触动器在静止状态;远端执行器处于横向抓紧运动状态;端部执行器钳颚在控制手柄的静止位置下张开并处于侧向大约30度角度;
图22是图18所示的端部执行器左侧的局部视图,端部执行器钳颚在静止位置下张开并处于侧向大约75度角度的位置;
图23是图18所示的端部吻合器的左侧局部视图,钳颚在静止位置和旋转的第一轴向位置下张开;
图24是图23所示的端部执行器的左侧局部视图,钳颚在静止位置和处于相对于图23逆时针旋转的正常位置张开;
图25是根据本发明的手术吻合装置的第二种实施方式的从远端看的立体图,它装有自带的吻合马达的可拆卸的端部执行器;吻合钳颚在静止张开位置和处于大约45度的右斜位;铰接球松放杆处于静态球捕获位置;马达起动按钮处于静止马达关闭位置;
图26是图25所示的可拆卸的端部执行器放大立体图,钳颚处于静止张开位置,为清楚起见,滑板已卸下;
图27是根据本发明的手术吻合装置的第三种实施方式的从远端看的立体图,它装有带两个球联接端和自带的吻合马达的可拆卸的端部执行器;吻合钳颚在静止张开位置和处于大约45度的右侧位,并且吻合钳颚是逆向的和面向近端;铰接球松放杆在起动的球释放位置,马达起动按钮在静止马达关闭位置;
图28是图27所示的可拆卸的端部执行器从右侧和远端看的放大立体图,钳颚在静止张开位置,为清楚起见,滑板已卸下;
图29是图25和26所示的外科手术吻合和切割装置的控制手柄最远端以及处于抓紧和对正状态的图25和26的可拆卸的吻合端部执行器的铰接球的局部放大侧视剖面框架图;
图30是图29所示的控制手柄相反一侧最远端局部放大侧面剖面图,绞接球处于不对正和松开状态,但是仍然抓在控制手柄的夹钳之间;
图31是根据本发明的吻合和切割装置从近端看的立体图,其中抵钉座已卸去;
图32是图31所示的装置的近端的局部立体图,其中手柄已卸下,显示出带有推杆的铰接松开装置的近端部分;
图33是图31所示的装置的内管近端零件放大分解图;
图34是连接端部执行器的铰接松开装置和铰接接头的内部零件从远端看的局部立体图,其中外管已卸下;
图35是图34所示的零件局部放大垂直纵剖面图;
图36是图31所示装置的刀片导杆组装件从刀片导杆近端到刀片远端的局部放大立体图,其中外管和内管已卸下;
图37是图35所示的零件的一部分的在拉带近端的局部放大垂直纵剖面图;
图38是图35所示的零件的一部分部分在拉带远端的局部放大垂直纵剖面图;
图39是图31所示装置的吻合器组装件、鼓套、铰接接头和U形叉的局部放大侧视图,其中抵钉座处于开放位置;
图40是相对于图39向远端移动的图31所示装置的吻合器组装件、鼓套、铰接接头和U形叉的局部放大侧视图,其中抵钉座处于闭合的击发位置;
图41是刀片导杆子组件从刀片导杆近端到刀片的局部放大立体图,其中刀片导杆、U形叉、左吊床、鼓套和钉仓保持器已卸下;
图42是图31所示装置的刀片推杆销接头的局部放大垂直横剖面图;
图43是图31所示装置的拉带铝管销接头的局部放大垂直横剖面图;
图44是图31所示装置的U形叉的近端面的局部放大垂直横剖面图;
图45是图31所示装置的柱塞销弹簧套和铰接松放销的局部放大垂直横剖面图;
图46是图31所示装置的柱塞销凸轮表面和铰接锁定链轮的局部放大垂直横剖面图;
图47是图31所示装置的端部执行器铰接接头的局部放大垂直横剖面图;
图48是图31所示装置的远端拉带销接头的局部放大垂直横剖面图;
图49是图31所示装置的抵钉座/上钳颚转轴槽的局部放大垂直横剖面图;
图50是图31所示装置的铰接接头部分的通过弹簧杆的局部放大水平纵剖面图;
图51是图31所示装置的刀片导向板和吊床的视图;
图52是图31所示装置的铰接接头部分通过铰接锁解锁滑板的局部放大水平纵剖面图;
图53是图31所示装置从远端看的远端部件的分解立体图,其中抵钉座已卸下;
图54是本发明的端部执行器的第四种实施方式的铰接远端部分立体图,其中内管和外管已卸下;
图55是图54所示的端部执行器的铰接部分在顶部超内向观看者旋转后的局部放大和分解立体图,其中外管已卸下;
图56是图54所示的端部执行器的铰接部分的局部放大底部平面图,其中下U形叉和闭合环已卸下;
图57是图54所示的端部执行器的铰接部分通过八字导块(dogboneguide)下端的局部水平纵剖面图;
图58是图54所示的端部执行器的铰接部分通过弹簧杆的局部垂直纵剖面图,其中内管和推杆-刀片支撑体已卸下;
图59是图54所示的端部执行器的铰接部分通过八字导块远端的局部垂直横剖面图;
图60是图54所示的端部执行器的铰接部分通过下U形叉的八字导向腔近端的局部垂直横剖面图,其中八字导块已卸下;
图61是图54所示的端部执行器的铰接部分通过八字导块中下部分的局部水平纵剖面图;
图62是图54所示的端部执行器的铰接部分通过八字块的中上部分的局部水平纵剖面图;
图63是图54所示的端部执行器的铰接部分通过弹簧杆的局部垂直纵剖面图,其中内管、推杆-刀片支撑体、抵钉座和大约一半缝合钉滑板已卸下;
图64是图54所示的端部执行器的铰接部分通过八字导块的局部垂直纵剖面图,其中弹簧板、抵钉座和大约一半缝合钉滑板已卸下;
图65是图54所示的端部执行器的铰接部分的远端的局部垂直纵剖面图,其中内管、推杆-刀片支撑体、抵钉座、闭合环和大约一半缝合钉滑板已卸下;
图66是图54所示的端部执行器的下U形叉、下八字叉、八字导块和三片相邻的刀片的立体图;
图67是图54所示的端部执行器的局部垂直横剖面框架图;
图68是图54所示的端部执行器的拉带的远端连接的替代实施方式的局部立体框架图;
图69是图68所示的远端连接的局部垂直横剖面图;
图70是图68所示的远端连接的一部分从下部看的局部立体图。
具体实施方式
本发明的各个方面在以下针对本发明的具体实施方式的说明和相关附图中公开。在不偏离本发明的精神或范围的前提下可以设计供选择的实施方式。另外,本发明的示例性实施方式中的众所周知的元件将不予详细描述或省略,以免无法突出本发明的相关细节。
在公开和描述本发明之前,应当知道,本文所用的技术术语只是为描述具体实施方式,而不是限制性的。必须注意,除非在文件中另有明确规定,在说明书和所附权利要求中使用的单数形式冠词包括复数指示物。
虽然说明书以限定本发明的新颖特征的权利要求为结论,但据信结合附图来考虑以下说明可以更好理解本发明,在各附图中,同样的部件用相同的附图标记表示。附图不是按比例绘制的。
现在来详细参阅附图,首先看图1,其中示出本发明的吻合和切割端部执行器的第一种示例性实施方式。端部执行器1的主要零件包括U形叉10、抵钉座20、用于安装钉仓100的钉仓保持器30、接合套筒40和横向移动或铰接装置50。图1表示缝合钉钉仓100可以从钉仓保持器30卸下。
缝合钉击发和组织切割滑块60将抵钉座20连接到钉仓保持器30和缝合钉钉仓100。滑块60可操纵地接合抵钉座20和钉仓保持器30,以保持20、30这两个零件适当对正,从而使钉仓100内被击发的缝合钉击打抵钉座20内的相应的吻合器抵钉座,将缝合钉固定在位于抵钉座20和钉仓100之间的组织周围。滑块60的面向远端的表面包括刀片62,当组织被钉合到一起后用于切割位于钳颚20、30内的组织。图1至图3显示滑块向近端移动。因此在图1和图3可以看到滑块60,抵钉座20与滑块60的上端没有结合。但是在操作时,滑块60必须与抵钉座20结合,如图2、特别是图13所示。
图2显示端部执行器1,为了能看到移动的各种特征,接合套筒40已卸下。
在图1至图3可以清楚看见横向移动装置50的两个主要零件的第一个。近端零件52包括近端链轮522、中间堞形连接器524和远端杆526。在示例性实施方式中,中间堞形连接器524有四个向远端突出的齿5242,清楚地显示在图2。
在图2还能看到拉索接头70,拉索接头70的近端连接到拉索110(点画线)的,其远端连接到钉仓保持器30。拉索接头70因此用于相对于抵钉座20拉动或推动钉仓保持器30,从而转动抵钉座20,使其根据钉仓保持器30的移动从张开变为闭合或从闭合变为张开。抵钉座20的近端的两侧有凸轮随动器22。钉仓保持器30在近端的两侧形成两个凸轮表面32,并对准,以接受相应的一个凸轮随动器22。因此,钉仓保持器向远端或近端方向移动导致抵钉座20相应地张开或闭合转动运动。
图4显示吻合器20、30相对于U形叉10作横向铰接运动。
在图5至图8,包括接合套筒40和U形叉10在内的所有零件用框架图表示,以此显示结构。U形叉10包括四个腔,其中两个显示在图5,在图6和图7显示所有四个腔。第一个腔12用于容纳未示出的轴,该轴用于控制端部执行器横向移动锁销120向远端和近端的移动,销120首先显示在图8和图9。两个横向腔14被成形为用于容纳向近端移动拉索接头70的拉线(拉索接头70向远端移动靠弹簧)。两个腔14中的另一个是备用的,可以容纳许多可能的其它装置。传动索腔16是四个腔中最后一个,被成形为用于容纳转动传动螺杆34的柔性传动索(见图1),该传动螺杆控制滑块60的移动。
在传动索腔16的远端,U形叉20限定椭圆形空腔18,用于容纳横向移动锁销120。图6至图9显示空腔18的示例性形状。由于横向移动锁销120的圆周形状是椭圆形的,所以锁销120不会从与链轮522的齿对正的位置转出。
在图5中U形叉10的两侧下面还可以看到两个定心弹簧130。弹簧130还显示在图6至图9,尤其显示在图10。为了防止弹簧130之间不希望的互相作用,在弹簧130之间夹有隔离板140。图10显示两个弹簧130和夹于二者之间的隔离板140。
根据图7至图10能更好地解释在透明套筒40下面的结构。套筒40限定两个外部结构和两个内孔。第一个外部结构是近端圆筒42。近端圆筒42在近端形成凸齿422。这些凸齿422与近端零件52的中间堞形连接器524匹配并互相作用。近端圆筒42还限定第一个孔44,其被成形为适于容纳近端零件52的远端杆526。在杆526与第一个孔44的内表面之间有圆筒形管状径向间隙,在拉索接头70的近端与第一个孔44的近侧内表面之间有纵向间隙。该管状间隙能容纳第一个管状偏置装置(例如螺旋弹簧),为清楚起见在图中未示出。第一个偏置装置被定位成对接合套筒40的最近端施加指向近端的力。在这种结构中,第一个偏置装置施加的力将远端凸齿422压向和靠紧近端齿5242。
接合套筒40的第二个结构是远端圆筒46。远端圆筒46形成了第二个孔48,它被成形为能容纳拉索接头70。拉索接头70还形成内孔72,它被成形为能容纳近端零件52的远端杆526。为了使附图清晰,在图9只用虚线表示杆526完全延伸到内孔72。在操作时,杆526完全延伸到内孔72。在示例性实施方式中,内孔72与第一个孔44同轴线并有相同的内径。因此,在杆526与内孔72的内表面之间存在圆筒样管状径向间隙,在拉索接头70的远端表面与内孔72的内侧远端表面之间存在纵向间隙。这是因为其可以成形为还能容纳第二个管状偏置装置(例如螺旋弹簧),为了清楚起见也未显示。提供的第二个偏置装置用于对拉索接头70施加指向远端方向的偏置力。这个力保持钳颚20、30在张开位置。因此钳颚20、30在静止张开位置。
在没有提供中间零件的情况下,两个未显示的偏置装置相连,形成一个弹簧。但是不希望两个偏置装置互相作用,因为有凸齿的零件分离将引起不希望的力施加到钉仓保持器30,钉仓保持器30的移动可能松开有凸齿零件的连接。因此,未显示的垫圈装在由拉索接头70的近端表面和第二个孔48的远端表面限定的圆筒形空腔74内的两个偏置装置之间。图7具体显示了用于固定这个垫圈的近侧,其被成形为仅仅容纳远端杆526通过。因此,由于垫圈被夹在拉索接头70和套筒40之间,两个弹簧被去耦合,互相独立提供各自的偏置力。
底视图图11和图12显示滑块60的传动轴34和近端惰轮衬套(idlerbushing)36,惰轮衬套将传动轴34保持在钉仓保持器30内的适当位置。在惰轮衬套36的位置,传动轴34没有螺纹。但是在惰轮衬套36的远端有螺纹,传动轴34有向远端延伸的螺纹(未示出)。图11和图12未显示传动轴34相反一端的推力轴承38,但是图1清楚地显示出推力轴承38。在图11、12和13中还以传动螺母64的形式显示出滑块60的底面。在示例性实施方式中,传动螺母64是一个与滑块60的滑板62分离的零件,不过固定连接在滑板62的底部。所显示的传动螺母64的剖面形状是哑铃形,为的是释放作用到螺纹上的某些力。在图11中,传动螺母64在近端位置,此时抵钉座20处于张开位置。与此相反,图12和13显示传动螺母在中间位置,此时抵钉座20处于部分闭合位置。
图13对于显示包括滑板62和传动螺母64的滑块60的形状和构型特别有用。
图14和图15中大致沿着端部执行器纵向轴线的水平剖面图对于显示远端杆526周围的孔特别有用。在此,为了清晰,在拉索接头70没有示出完全延伸到孔72的远端表面的杆526,尽管实际上完全延伸到这个表面。围绕杆526近端的是接合套筒46内的第一个孔44。紧靠第一个孔44远端的是空腔74,用于容纳垫圈,紧靠空腔74远端的是拉索接头70的内孔72,用于容纳第二个偏置装置。
图16中大致沿端部执行器的纵向轴线的垂直剖面图对于观察传动螺母64和传动轴34之间的连接特别有用。为了清晰,在拉索接头70没有示出完全延伸到孔72的近端表面的杆526。
图17中大致沿端部执行器的纵向轴线的垂直剖面图对于观察滑块60与抵钉座20和钉仓保持器30之间的连接特别有用。两个上翼66设于抵钉座20内部的槽内,两个下翼68形成由下翼68和传动螺母64构成的工字形架的上支承表面。
图18至图24显示带有远端执行器1和第一种示例性实施方式的控制手柄2的本发明的吻合装置的整个纵向范围。如图60所示,钳颚20、30静止于张口位置。
拇指扳机连接到终点在拉索接头70的拉索近端。这样,当操作拇指扳机3时(见图19),向近端方向拉钉仓保持器30。由于凸轮表面32的形状,导致凸轮随动器22移动,从而使抵钉座20绕枢轴转动到大致吻合位置。如上面所述,保证抵钉座20的定向与钉仓保持器30适当平行、从而与钉仓100适当平行的不是拇指扳机3,而是滑块60保证适当的平行定向。
图20至图22显示端部执行器1如何在侧向作被动铰接活动。当按下食指扳机4时,侧向运动锁销120向后移动,脱离链轮522。如果没有力作用到端部执行器1,则由于有两个定心弹簧130,端部执行器1保持在图18和19所示的轴线对正的方向。然而当外力作用到端部执行器1时(如图20所示),侧向自由的端部执行器1可以绕链轮522的轴线移动到任何位置,例如图20所示的向左大约45度的位置,或向任何其它方向,见图22的例子。当松开食指扳机4时,锁销120的远端退回到链轮522的两个齿之间,阻止侧向运动。因此,例如在图21和22所示,端部执行器可以锁定在许多侧向铰接的位置。应当注意,为了清晰,在图18至24没有示出钉仓100。
图23和24显示端部执行器的轴向转动控制。这种轴向控制分别由接合套筒40和侧向移动装置50的两个相应的凸齿结构422、5242提供。在图23,凸齿接合,抵钉座相对于手柄在90度位置。为了使凸齿脱离,对端部执行器1施加足以克服第一偏置装置的力。然后,端部执行器1能够顺时针方向或逆时针方向转动。例如,图68显示抵钉座20逆时针转动到大约9点钟位置。
可以用图1至图3显示本发明的吻合装置以电机驱动的吻合功能的操作。在图1中,滑块60在近端位置。在手柄中装有可反转的马达,马达与一个三向开关联接。当开关在中间位置时,马达停止。当开关在近端位置时,马达转动,使传动轴34转动,从而使滑块60向近端方向移动。反之,当开关在远端位置时,马达转动,使传动轴34转动,从而使滑块60向远端端方向移动。当然,可以只用双向开关,没有停止位置。
图25和26显示本发明的吻合和切割系统200的第二种示例性实施方式。与第一种实施方式不同,系统200的电动吻合组装件完全装在端部执行器210内,因此,手柄220只需要有两个起动装置。第一个起动装置222是一个球铰连接松放杆,第二个起动装置是吻合/切割马达开关按钮224。
端部执行器210用球铰接头228连接到手柄220的驱动轴226的远端。端部执行器210在其最远端有球铰连接212。球铰连接212有两个相对的杯形夹子2122、2124。杯形夹子2122、2124的内表面的形状与球铰连接212的外表形状相对应。杯形夹子2122、2124根据起动杆222的起动互相靠近或互相分开。
杯形夹子2122、2124在闭合位置时互相偏离,使得当球铰212处于此位置时,两个杯形夹子2122、2124紧紧地握住球铰212。扳动起动杆222使杯形夹子2122、2124分开,从而使球绞212在两个杯形夹子2122、2124之间自由转动。因此,当扳动起动杆222时,端部执行器210根据施加到周围结构,例如靠近吻合/切割部位的组织的压力而自由运动。起动杆222可以向下推到足够远的位置,使球铰212完全移出杯形夹子2122、2124。因此,如果第一个端部执行器210被夹在第一个部位,第二个端部执行器210需要抓住和切割第二个部位,则第一个端部执行器210可以保持夹在第一个部位,轴226可以从身体取下,装上第二个端部执行器210并将其导入第二个部位。
当使用者希望用端部执行器210进行吻合和切割时,需要第二个起动装置224。当端部执行器210在所要求的吻合/切割位置时,按下致动器224(例如按钮)。这种起动优选接通(或切断)端部执行器210内的连接电源与马达的电路,从而使滑块60向远端移动,实现钳颚的吻合和切割功能。
图25显示端部执行器210可以完全自由地定位在相对于球铰212的任何位置。在图25中,端部执行器210处于大约45度的右侧位,抵钉座的方向大约在90度。
图27和28显示在图25和26所示出的端部执行器的第二种实施方式的变型。控制手柄220与图25、26中的相同。但是端部执行器310不同。具体讲,端部执行器310有一个与图25和26中的球铰212类似的近端球铰312,而且还有第二个远端球铰314,其形状与近端球铰312几乎相同。因此,当按下起动杆222以松开球铰312、314时,可以允许端部执行器310停在身体内,相对一端被杯形夹子2122、2124之间握住。在图27所示的这种定向下,当钳颚开口朝向使用者时可以实施吻合/切割。
还应当注意,在手术部位放置端部执行器210、310,有时需要接近的手术部位与端部执行器210、310张开的钳颚比较要小得多。由于具有倒转端部执行器310的能力,所以可以进入单球绞端部执行器210不能到达的一些难以达到的部位。
图29和30显示图25至图28中的手术吻合和切割装置200、300的驱动轴226最远端的杯形夹子2122、2124,该球铰碗夹紧图25至28中的端部执行器210、310的球铰212、312、314。这些图显示起动杆222连接到推杆230,推杆远端有柱塞232。柱塞232的最远端有杯形表面234,其形状对应于球铰212、312、314的外部形状。因此,当柱塞232在其最远端位置与球铰212、312、314接触时,球被抓紧,不能移动或转动。反之,当柱塞232如图30所示向近端移动时,球铰212、312、314的球在杯形夹子2122、2124之间自由转动。
在图31至图70中显示的内吻合器对图1至图30所显示的内吻合器增加了各种不同的替代和/或补充的结构。
在图31至70全部图中,为了能看得清楚,只在图39和图40示出了上钳颚或抵钉座1020。此外,由于在图1至图30详细描述过抵钉座20,下面不再重复描述。
图31所显示的示例性控制手柄由Ethicon内镜外科公司制造,可以在比如Ethicon的ECHELON 60直线切割型Endopath吻合器上看到。因此这种控制手柄的描述认为是多余的,因为这种控制手柄的零件和功能说明在本领域中被公开。这种描述在本文作为参照全文并入本申请。
如上所述,本发明的内吻合器的远端被设计为能容纳标准钉仓100。这种钉仓100也在现有的出版物中描述过,本文也不再重复。这些出版物也作为参照全文并入本申请。
图31显示本发明的内吻合器1000的可供选择的实施方式的一部分。应当注意,为了清晰,内吻合器1000的手柄1200上的两根远端起动杆在图31中没有示出。
控制手柄1200的远端包括钟形起动器1100,它对内吻合器1000的铰接部分提供两种控制。第一种控制:钟形起动器1100在手柄1200的远端绕内吻合器1000的中心轴线自由转动。由于钟形起动器1100可转动地固定连接到外管1110,当钟形起动器1100顺时针或逆时针方向转动时,内吻合器1000的整个远端相应地转动。第二种控制:钟形起动器1100在控制手柄1200的远端能够向近端方向移位给定的距离。如下面将要详细描述的,钟形起动器1100向近端方向的位移引起铰接锁解锁滑块120、1120相应的移动,从而允许远端执行器1002在移动装置50、1050上作铰接活动。位于例如钟形起动器1100远端部分的没有示出的偏置装置(即压缩弹簧)的作用是将钟形起动器1100和铰接锁解锁滑块1120在远端方向上偏置,以便当钟形起动器1100在未起动状态时,使铰接锁解锁滑块120、1120保持在起动或锁定位置。见图8和图9。这个偏置装置装在钟形起动器1100内,但是为了清晰,在图32未示出。安装在内管1130环槽1139内的卡环也没有示出。偏置装置定界在杆拉块1105(见图34)的近端侧和卡环的远端侧。在这种结构中,当钟形起动器1100被拉向近端时,钟形起动器1100向近端对杆拉块1105施加力,从而将铰接锁解锁滑块120、1120移动到解锁位置。在钟形起动器1100的内表面的一个键槽以形状锁定方式包绕杆拉块1105,因此钟形起动器1100绕内管1130的纵向轴线的转动迫使杆拉快1105相应地转动。形状锁定或形状配合连接是两个元件因自身的形状连接在一起,与此相反的是力锁定连接,它是用从外部施加到两个元件上的力将两个元件锁定在一起。这样内管和装置1000的整个远端组装件也转动。在可供选择的构型中,钟形起动器1100的纵向移动类似于标准圆珠笔的作用,第一次起动将滑块120、1120放在解锁状态,第二次起动将滑块120、1120放在锁定状态。
用本发明的钟形起动器1100,医师用一只手能够实施内吻合器的每一种功能。
图32显示不带控制手柄1200时内吻合器1000的近端。推杆1102同轴装在钟形起动器1100内部,用于当吻合器处于击发方向时移动切割刀1060。
图33显示轴向固定地和可自由旋转地将远端组装件连接于钟形起动器1100的内吻合器1000的近端零件。更具体地说,内管1130(装在外管1110内)有近端延伸段1132,它限定内管偶联腔1134。蛤壳式衬套1131的长度基本上等于内管1130的延伸段1132的长度,衬套偶联腔1133对应于近端延伸段1132的偶联腔1134。转动联接器1141有远端T形转动联接盘1143,其外形对应于联接腔1133和1134,因此,当联接盘1143位于延伸段1132与衬套1131之间时,联接盘1143在此处自由转动。联接器1141通过其近端孔1145固定在控制手柄1200内部。
当装配到一起后,内管1130相对于联接器1141轴向固定,但是可独立于联接器1141转动。因为三个偶联零件1130、1131、1141的尺寸与外管110的内部相配,当三个零件装到外管1110内部时,外管1110成为形状锁定连接,防止内管1130和衬套1131分离(只要外管1110充分覆盖该范围)。因此,当钟形起动器1100绕内管1130的纵向轴线转动时,内管和外管1110、1130能够绕1110、1130的共同轴线转动,但是相对于纵向固定在手柄1200内部的联接器1141保持纵向稳定。
图34显示不带控制手柄1200、钟形起动器1100和外管1110的内吻合器1000的近端。正如所看到的,内管1130是空心管,管内通过后面将要详细描述的推杆1102。图中还显示U形叉1010和鼓套1040,这些零件共同形成内吻合器1000的铰接连接或接头1050。
在这里应当注意,下钳颚/钉仓保持器1030相对于控制手柄1200是纵向固定的。与这种固定相反,上抵钉座1020能够绕枢轴转动,并且通过形成键槽的凸轮表面32滑动而闭合和/或张开钳口时有一定程度纵向移动(关于凸轮表面1032后面详细描述)。
为了形成钉仓保持器1030与控制手柄1200的纵向固定连接,内管1130必须连接到钉仓保持器1030。但是钉仓保持器1030必须同时能够相对于内管1130的纵向范围作铰接活动。因此,在1030、1130两个零件之间必须存在轴向固定而侧向铰接的连接。
为了提供这种连接,本发明至少包括一条拉带1140,例如在图35至图38所示。在一种示例性结构中,一个接一个地提供多条拉带1140。三或四条拉带形成两种可能的结构。使用两条拉带1140与一条比较,纵向强度保持大约相同,但是横向弯曲拉带1140需要的力减小。对于三条或四条拉带1140也是如此。图37显示拉带1140的近端,它用近端拉带销1142纵向连接到内管1130的远端。为了在拉带1140与内管1130之间提供牢固的连接,在内管1130的远端与拉带1140之间装一个例如用黄铜制造的近端导向块1150。
如图35所示,拉带1140跨越整个铰接接头1050,并且如图38所示连接到远端导向块1160。远端导向块1160(例如也用黄铜制造)至少有一个突出部固定在钉仓保持器1030近端的至少一个凹槽内。后面的图显示远端导向块1160连接到钉仓保持器1030的方式,以便最终使钉仓保持器1030轴向固定连接到控制手柄1200,同时能够相对于内管1130作铰接活动。如图38所示,远端拉带销1144将拉带1140的远端轴向锁定在远端导向块1160上。
钳颚20、30的运动的第一种实施方式在上文已经描述。其中钉仓30轴向移动,抵钉座20相对固定。在图31及以后的图中所显示的内吻合器1000的结构中,运动在操作上与上面所描述的相反。
注意到钉仓保持器1030相对于控制手柄1200是纵向固定的,仍然必须有一个组装件使两个钳颚20、30;1020、1030闭合。因此闭合是由在下文中描述的上钳颚/抵钉座1020的运动完成的。
控制手柄1200(例如近端手柄)的两根起动杆中的第一根可操作地连接到外管1110,当压下/起动第一根起动杆时,向远端移动外管1110。由于U形叉1010、铰接接头1050和鼓套1040轴向固定地连接到外管1110(又因为外管1110能沿内管1130纵向滑动),操纵第一根操纵杆时使鼓套1040向远端移动。
图39显示张开状态的抵钉座1020。可以看到,在鼓套1040的远端与钉仓保持器1030底部的近端架之间存在间隙1031。在这种定向中,鼓套1040、U形叉1010和外管1110在近端与所述架有一定距离。
图40显示闭合状态的抵钉座1020。可以看到,在鼓套1040的远端与钉仓保持器1030的近端架之间不存在间隙1031。在这种定向中,鼓套1040、U形叉1010和外管1110处于鼓套1040与近端架接触的位置。
与钉仓保持器1030相对于控制手柄1200轴向固定相反,而类似于鼓套1040的移动,刀片60、1060必须相对于控制手柄1200沿纵向轴线移动。图35、36和图38至41显示刀片1060与控制手柄1200的刀片移动结构的可轴向位移的连接。
关于图35,推杆1102从控制手柄1200伸出并连接到控制手柄1200的未示出的第二根起动杆(例如远端起动杆)。推杆1102的远端通过推杆销1122连接到至少一个柔性刀片1062。刀片1062的远端连接到切割刀1060的近端侧,使得切割刀1060随着推杆1102的移动相应地向远端或近端移动。应当注意,刀片1062有一个近端向上延伸的接盘1064,它具有一个内孔容纳推杆销1122。推杆1102与刀片1062之间的这种离轴连接导致当刀片1062被推向远端时,其远端被迫向下,从而保持在推杆-切割刀支承体1070内部的位置,例如图36和图42所示。
刀片1062有足够的柔性,能够以铰接接头1050的任何弯曲方式弯曲。因此,刀片1062如果没有支承,也有足够的柔性有可能扭曲。因此本发明提供一个推杆-切割刀支承体1070,显示在图36和42。在此处,推杆-切割刀支承体1070的近端清楚地显示出矩形刀片槽1072,用于可滑动地支承矩形刀片1062。还示出一条弯曲推杆槽1074,用于可滑动地支承推杆1102的弯曲(例如圆柱形)的外部。因此,推杆-刀片支承体1070在推杆1102位于支承体1070内部的位置支承推杆1102,在刀片1062位于支承体1070内部的位置也支承刀片1062。
图36显示支承体1070的连接及其与近端导向块1150的关系。
和拉带1140一样,可以有一个以上的刀片1062相互紧挨着。在这种结构中,多片刀片1062有相同的纵向刚度,但是在铰接接头1050处弯曲时提供更高的柔性。
图41显示铰接锁解锁滑块1120,用于锁定钳颚1020、1030的绞接运动。
图42至图50显示控制手柄1200的管远端部分沿与内吻合器1000的纵向轴线正交的平面的垂直剖面图。
图42显示刀片1062与推杆销1122连接处的剖面图。推杆销1122穿入整个两个相邻的刀片1062和推杆1102,但是没有伸出推杆外表面。该图还显示内、外管1130、1110和推杆-切割刀支承体1070的关系。从该图中还可以看到用于松开解锁滑块1120的解锁拉杆1104。解锁拉杆1104的纵向范围在图35第一次示出,也在图36、37、41、52和53中示出。通过去掉外部零件,图41最具体地显示出拉杆1104如何将钟形起动器1100与铰接锁解锁滑块1120连接在一起。由于拉杆1104的远端穿过并包绕在铰接锁解锁滑块1120,如图37所示,解锁拉杆1104便形成钟形起动器1100与铰接锁解锁滑块1120之间的纵向固定连接。因此,当钟形起动器1100向近端移动时,铰接锁解锁滑块1120向相应的近端方向移动,使铰接锁解锁滑块1120的远端齿1121与链轮1522的齿1014分离。尤其见图46和52。应当注意,拉杆1104与铰接锁解锁滑块1120之间的包绕连接只是一种示例性实施方式。也可能有其它形状锁定或外力锁定连接。
图43显示通过拉带1140和内管1130销接头的连接。如前面的描述,近端拉带销1142穿入整个刀片1062、近端导向块1150和内管1130,但是没有穿过外管1110。
图44显示紧邻铰接锁解锁滑块1120近端的区域。在该示例性实施方式中,两条拉带1140装在两个刀片1062的上方。为了对拉带1140和刀片1062中的至少一个提供支承,沿拉带1140和刀片1062的铰接部分侧面装有一对吊床1066。每个吊床1066呈U形(沿纵剖面),以便使每个吊床1066的近端臂围绕U形叉1010的近端表面弯曲、每个吊床1066的远端臂围绕鼓套1040内的锁紧表面弯曲,如图50所示。
在U形叉1010内侧装有两个弹簧杆1012,其上装有弹簧杆环1014,弹簧杆和环的作用是将铰接接头1050的整个组装件的远端沿纵向轴线侧向偏置。弹簧杆和环1012、1014将在下面进一步详述。
图45显示铰接锁解锁滑块1120中心的开放区,用于容纳拉杆1104的弯曲部分(图中未示出)。还显示空腔1016,用于容纳未示出的弹簧杆1012上的偏置弹簧。该剖面图还包括装在两个刀片1062上方的两条拉带1140的一部分。
图46显示弹簧杆1012的远端作用于凸轮表面1018的开放区。应当注意,凸轮表面1018成弧形,以便使弹簧杆1012与凸轮表面1018之间的接触始终在与弹簧杆1012的最远端的表面正交的轴线方向接触,通常在接触。见图56的例子。在这种结构中,弹簧杆1012施加到凸轮表面1018以使远端铰接组装件(例如抵钉座1020、钉仓保持器1030、鼓套1040)向内管和外管1130、1110的纵向轴线偏置的力始终处于绕绞接钉仓保持器1030的铰接轴线的相同的半径上。这种结构的一个优点是弹簧杆1020决不会被施加侧向力,在该情况下,弹簧杆1020的最远端能够抓住并锁定在凸轮表面1018上。
图47显示内吻合器铰接接头1050内部区域的剖面图。同样,这个区域也包括两条拉带1140、两个刀片1062和两个吊床1066的部分。上、下轴圆盘1152插入鼓套1040表面的上方和下方小孔1042内。U形叉1010与鼓套1040在铰接接头1050的连接在顶部和底部是对称的。圆盘1152插入鼓套1040近端的顶部和底部的小孔1042内。在这种定向中,该组装件被插入U形叉1040的远端,将螺钉孔1011与圆盘1152的中心螺纹孔1153对正。当对正以后,螺钉1013分别拧入圆盘1152,将鼓套1040轴向固定在U形叉1010,同时允许鼓套1040围绕由两个螺钉1013的纵向轴线确定的轴线作铰接运动。
图48显示远端拉带销接头区域。在该区域,拉带1140的远端用装在远端导向块1160的孔内的远端拉带销1144固定。远端导向块1160装在钉仓保持器1030上和按前面描述的方法固定。
图49显示紧靠切割刀1060近端的区域和两个刀片1062在切割刀1060近端小孔内的固定连接。该图还清楚地显示凸轮表面1032,它允许抵钉座1020绕枢轴转动和相对于钉仓保持器1030移动。
图50显示通过弹簧杆1012的纵剖面图。在该图可以看到吊床1066的整个纵向范围。吊床1066的远端部分绕靠近吊床1066远端的垂直轴线作铰接活动。在图50中,在弹簧杆1012与吊床1066之间存在空隙。如果没有吊床1066,薄的刀片1062很可能在这些间隙中弯曲和扭曲或扭结。通过在刀片中间放上吊床1066,防止刀片1062发生任何不允许的弯曲的可能性。图51显示在专门的弯曲试验台上吊床1066及其中间的刀片1062的极限弯曲范围。应当注意,在图51中,对于向上弯曲不使用上吊床1066,因为它沿临界弯曲区的弯曲内表面移动。相反,使用下吊床1066,基本上防止吊床中间的刀片1062(在该示例性实施方式中是两个刀片)向试验台的空隙内产生不允许的弯曲。因为每个吊床1066的两端刚性地固定和用充分没有弹性的材料制造(例如不锈钢),从而形成支撑其间的弯曲的刀片1062的吊环或“吊床”。
图52显示通过铰接锁解锁滑块1120的剖面图,清楚地显示滑块1120内的解锁拉杆1104的远端连接弯曲部。在这种结构中,解锁拉杆1044向近端的移动引起滑块1120相应地向近端移动,使滑块1120的齿1121与鼓套1040的近端对应的齿解离。在图中未示出的偏置装置对铰接锁解锁滑块1120施加远端偏置力,该偏置装置位于空腔1123内,紧抵空腔1123的远端和相对于U形叉1010固定的块体1124。
图35显示解锁拉杆1104与手柄1200之间的连接。杆拉块1105有纵向孔1107,用于容纳拉杆1104。杆拉块1105还有横向孔1109,容纳未示出的用于将拉杆1104固定在杆拉块1105内的固定螺钉。钟形起动器1100内部被成形,用于接合杆拉块1105(例如,键槽类形状配合连接),当钟形起动器1100向近端移动时,使杆拉块1105也向近端移动。
图53是内吻合器远端零件从远端看的分解立体图。
应当注意,在图34至图53,U形叉1010是单体零件。另一种U形叉1010可以模压成两件。在这种情况下,可以取消圆盘1152,代之以形成两件半U形叉的每一件的一部分,因此不需要螺钉1013,因为当外管1110在连接到U形叉1010的近端时,将两件半U形叉固定在一起。这种结构显示在图54及以后各图的内吻合器实施方式中。
图54显示端部执行器第四种实施方式的某些内部零件。抵钉座1020安装在钉仓保持器1030的对侧,闭合环1040围绕钉仓保持器1030的近端。内、外管1130、1110已卸下,以便能看清楚铰接锁解锁滑块1120、推杆1102和推杆-切割刀支承体1070。在内、外管1130、1110和钟形起动器1100内部围绕推杆1102装有屏门1103。为了清晰,手柄1200和钟形起动器1100已卸下。屏门1103限制推杆1102只能向一个方向,即远端移动,因为刀片/切割刀1060只能向远端移动。
图55和56最清楚地显示出两件式U形叉。这两个图显示出图54的端部执行器卸下外管1110后的各种内部结构。在图55的分解图中,显示出拉带1140与钉仓保持器1030的连接。未示出的销(还参看图59)分别穿过保持器1030的第一个近端接盘、第一个隔环1170、拉带1140的远端接盘、第二个隔环1170和保持器1030的第二个相对的远端接盘。如图59所示,闭合环1040固定住所述销,将这些部件纵向连接起来。
刀片/切割刀1060的各种结构也显示在图55。切割刀1060有近端凹口1061,用于连接刀片1062的远端。在示例性实施方式中,口1061和远端形成键槽形锁。切割刀片1060的上半部分有两个相对的导向翼1063,其外部形状与上抵钉座1020底面内的对应的槽配合。切割刀片1060的下半部分也有两个相对的导向翼1065。保持器1030顶面内有槽,用于配合下翼1065。这两对翼1063、1065保证在切割和吻合过程中切割刀1060来回移动时抵钉座1020和保持器1030处于固定的平行位置。在切割刀1060下半部分还装有向近端延伸的接盘1067。一个板弹簧1090通过铆钉1036连接到钉仓保持器1030。板弹簧1090和切割刀1060的其它结构将在后面更详细地描述。
图55和56还显示两件式U形叉2010、2020的各个部分。如图56和58所示,U形叉上半部分2010的内表面形成两个空腔2011,两个空腔分别容纳弹簧杆1012和未示出的弹簧杆1012的偏置装置。在给出的示例性实施方式中,U形叉上半部分2010形成完整的空腔2011,用于容纳弹簧杆1012;U形叉下半部分2020形成底部空腔部分2021,只用于容纳偏置装置。半U形叉2010、2020还形成铰接口2012、2022,用于容纳两个八字叉零件2030、2040上的铰接凸起部2031、2041。
图56和57显示外管1110内部结构的纵向连接。推杆-切割刀支承体1070装在内管1130下部槽内。推杆-切割刀支承体1070还有一个远端延伸段1071,它带有窄的近端颈部1074和比较宽的远端头1075。由于下半U形叉2020底部有相应的凹口2023,延伸段1071能够纵向固定于半U形叉2020,从而固定到U形叉其余部分。
为了显示弹簧杆空腔2011内的弹簧杆1012的结构,在图56中外管1110和下半U形叉2020已卸下。为了清晰,空腔2011内的弹簧杆偏置装置(例如螺旋弹簧)没有示出。在图56由于卸下各个零件,拉带1140的铰接范围清楚地显示出来。在图58的剖面图中可以看到上半U形叉2010内侧拉带1140的支承表面。上八字叉2030有两个相对的支承面2032,每个支承面与没有铰接的拉带1140的中心线形成相似的锐角。同样,上半U形叉2010有两个相对的支承面2013,每个支承面与没有铰接的拉带1140的中心线形成相似的锐角。
图55和58显示与下半U形叉2020向内方向相反的视图。刀片1062的铰接部分与下八字叉2040内的八字导块1080的支承面2042和下半U形叉2010内的八字导块1080的支承面2024一同显示出来。在这个定向中还能看到八字导块的导向和支承面。在图57可以看到下八字叉有肾形远端八字凹口2043,下半U形叉2010有肾形近端八字凹口2025。这些凹口2025、2043和表面2024、2042还显示在图66,并且将在后面详细说明。在图59、62和66可以看到的进一步的结构是八字导块1080的内部通道,它具有左右表面1082,将在后面详述。
图59的垂直剖面图显示八字导块1080的远端。远端八字凹口2043容纳八字导块1080的远端,当没有铰接时,八字导块1080不接触下八字叉2040的支承面2042。
图60显示容纳八字导块1080远端的近端腔室。为了更好地显示近端八字凹口2025的结构,图中卸下八字导块1080。
图57显示带有八字导块1080的下延伸部分的凹口2025、2043的水平纵向横剖面图。还显示推杆-切割刀支承体1070下部结构、切割刀1060和缝合钉滑板102(是可拆卸的钉仓100的一部分)。这些结构在图61和62被放大。
图63、64和65显示刀片1060锁定结构。换言之,它是当钉仓保持器1030内没有钉仓100或预先击发的钉仓100时,防止刀片1060向前移动的安全结构。为了容易理解,在这些图中只显示钉仓100的缝合钉滑板102。
只有当缝合钉滑板102处于准备击发位置,即滑板102处于图65所示的位置时才允许刀片1060向远端移动。如果滑板102不是处于这个位置,这意味着可能有两种情况,或者在钉仓保持器1030内没有装钉仓100,或者滑板102已经向远端移动—换言之,装好的钉仓100已经发生部分击发或完全的击发。这样,切割刀1060不应当允许移动、即应当限制其移动。因此滑板102有锁定接触面104,切割刀1060有形状对应的接触头1069。在这里应当注意,只有在切割刀1060向远端移动通过边缘1035时下导向翼1065才支承在钉仓保持器1030的底板1034上。用这种结构,如果滑板102没有处于切割刀1060的远端而支撑头部1069,则下导向翼1065将跟随紧邻边缘1035近端的凹口1037,并且不是在底板1034上向前移动,而是碰撞边缘1035,停止切割刀1060继续向前移动。当滑板不存在时,为了有助于这种接触,钉仓保持器1030有一个板弹簧1090(用铆钉1036连接)。板弹簧1090向上弯曲、向下压住接盘1067(至少直到接盘1067达到板弹簧1090的远端的末梢),向下的力施加到切割刀1060,将导向翼1065向下压入凹口1037。因此,当切割刀1060向远端移动而没有滑板102时,导向翼1065沿着凹口1037的下曲线移动,当导向翼1065的远端边缘碰到边缘1035时,停止继续向远端移动。图63例如显示远端边缘1035和两个高出的凸起部1038,该凸起部伸到边缘1035的高度,确保在没有滑板102时导向翼1065不被推过边缘1035。
图66显示八字导块1080在下半U形叉2020和下八字叉2040内的示例性移动。在图66铰接转动到最左侧的位置,八字导块1080的远端底部凸出处于在远端八字凹口2043内转动的位置,而近端底部凸出处于在近端八字凹口2025内转动的位置。重要的是八字导块1080的左垂直表面几乎完全支承在左八字支承面2024、2042上。口2025、2043和八字导块1080的底部凸出的形状经过选择,使得不延长或压缩八字导块1080,而仅仅在端部执行器作铰接运动时左右摇动。
三个并列的刀片1062示意性表示在图66的下半U形叉2020、2040的左铰接位置之内。当向左弯曲时,刀片1062被压向八字导块1080的右侧内表面1082。因此,内表面1082的形状取决于端部执行器铰接转动的程度。由于绘图的限制,刀片1062只用概略的近似弯曲的方向示出。
为了更好地理解刀片1062的某些结构,图67显示出放大的与推杆1102和推杆-切割刀支承体1070的近端连接。在图41和图67的例子中,刀片1062与推杆1102偏置连接,但是可以设想二者的同轴线排列结构。如前面所述,刀片1062的长度适合于将其向下完全压入推杆-切割刀支承体1070内的刀片槽1072内。图41显示将刀片1062偏置到槽1072内的第一种偏置连接的实施方式。图67显示这种偏置连接的第二种实施方式。在第二种实施方式中,刀片1062不是像第一种实施方式那样(用横向推杆销1122连接)固定地连接到推杆1102。而是推杆1102有一个空腔1108,刀片1062的近端插入这个空腔内。通过使刀片1062在纵向轴线方向固定的方式形成空腔1108(例如有横向偏置),不需要固定连接。在这个实施方式中,空腔1108在垂直断面近似于L形,以便提供横向偏置,也可以是许多不同形状。
拉带1140的远端连接在图59显示得特别好。应当注意,在这种结构中,向左或向右铰接活动使这两条、三条、四条或更多条相邻的拉带1140弯曲。因为每一条拉带1140有固定的长度和各条拉带互相叠靠在一起,在给定方向的铰接运动使每一条拉带1140的弯曲不相同,尽管这种差别很轻微。为了补偿这种弯曲的差别,另一种远端连接的实施方式表示在图68至70。为了清晰和简化,在这些图中只示出上八字叉2030的示意图。
这种替代实施方式更换了第一种装置中的隔环1170。在这里,五条拉带1140并列安装。上八字叉2030形成一个内孔2033(例如圆孔),在孔内插入活塞2050,活塞的外形与孔2033的内部形状对应。孔2033有近端窗口2034,拉带1140从窗口伸进孔2033。窗口2034的宽度近似地等于(但正好略大于)拉带1140的总宽度。
活塞2050有横向孔,孔内拧入近端拉带销2060,它穿过活塞2050和每条拉带1140的远端拉带孔1145,其功能就像一根轴。见图70。活塞2050的内部2051的形状与堆叠的拉带1140的宽度不对应。相反,容纳拉带1140远端的内孔具有翼状水平横截面形状。
当端部执行器作铰接运动时,拉带1140的远端弯进曲面。当相邻的平行板,例如拉带1140一起弯曲时,外侧板的运动不同于中间或内侧板。这种不均匀的移动用翼状开口2051和椭圆形远端拉带孔1145补偿。随着端部执行器的铰接运动,施加到拉带1140的弯曲力导致活塞2050在上八字叉2030的孔2033内转动。端部执行器的铰接运动越大,活塞2050的转动也越多,直到最大铰接活动将外侧拉带1140压向翼状开口2051的内表面。此时,每条拉带1140的近端对齐,远端不对齐,如图68至70所示。椭圆形拉带孔1145的存在允许各条拉带1140互相之间略有移动。
以上的描述和附图显示了本发明的原理、优选的实施方式和操作模式。但是,本发明不应被视为局限于上述具体实施方式。本领域技术人员会知道上述实施方式的其它变型。
有鉴于此,以上所描述的实施方式应当被认为是示范性的,而不是限制性的。因此,在不脱离由下列权利要求所确定的本发明的范围的前提下,本领域技术人员可以对这些实施方式进行许多改变。
Claims (45)
1.一种医疗装置,包括:
控制手柄,该控制手柄具有:
缝合钉起动器;
绞接接头起动器,该铰接接头起动器与所述缝合钉起动器不同且具有未起动状态和起动状态;
本体,所述缝合钉起动器和所述铰接接头起动器横贯过该本体,所述本体限定一纵向轴线;
手术吻合端部执行器,该手术吻合端部执行器具有:
抵钉座;
缝合钉仓,具有至少一个缝合钉;和
抵钉座-钉仓控制装置,其可操作地连接到所述缝合钉起动器、所述抵钉座、所述缝合钉仓,并在所述缝合钉起动器被起动时吻合所述至少一个缝合钉;
被动铰接接头,该被动铰接接头将所述吻合端部执行器连接到所述控制手柄并绕一铰接轴线铰接;
所述缝合钉起动器的一部分穿过所述被动铰接接头并以与所述被动铰接接头的铰接相对应的方式挠曲;以及
所述绞接接头起动器:
当处于所述未起动状态时,将所述被动铰接接头和从而也将所述端部执行器保持在基本固定的铰接位置;以及
当处于所述起动状态时,松开所述被动铰接接头,使其处于自由铰接状态,允许所述端部执行器根据施加于所述端部执行器的外力进行自由铰接。
2.根据权利要求1所述的医疗装置,其特征在于,所述铰接接头起动器当处于起动状态时,松开被动铰接接头,使其处于自由铰接状态,允许所述端部执行器根据施加于该端部执行器的外力相对于所述控制手柄进行自由铰接。
3.根据权利要求1所述的医疗装置,其特征在于,所述铰接接头起动器当处于起动状态时,松开被动铰接接头,使其处于自由铰接状态,允许所述端部执行器根据施加于该端部执行器的外力围绕所述铰接轴线进行自由铰接。
4.根据权利要求1所述的医疗装置,其特征在于:
所述铰接接头起动器有一个带有指向远端的齿的拉动锁;
所述吻合端部执行器有一个带有指向近端的齿的齿轮:
当所述铰接接头起动器处于所述未起动状态时,所述指向近端的齿与所述指向远端的齿互锁;以及
当铰接接头起动器处于所述起动状态时,将指向远端的齿与指向近端的齿分离,从而松开所述被动铰接接头至所述自由铰接状态。
5.一种医疗装置,包括:
控制手柄,该控制手柄具有:
缝合钉起动器;
绞接接头起动器,该铰接接头起动器与所述缝合钉起动器不同且具有未起动状态和起动状态;和
本体,所述缝合钉起动器和所述铰接接头起动器横贯过该本体,所述本体限定一纵向轴线;
手术吻合端部执行器,该手术吻合端部执行器具有:
抵钉座;
缝合钉仓,具有至少一个缝合钉;
抵钉座-钉仓控制装置,其可操作地连接到所述缝合钉起动器、所述抵钉座、所述缝合钉仓,并在所述缝合钉起动器被起动时吻合所述至少一个缝合钉;和
铰接锁;
被动铰接接头,该被动铰接接头将所述吻合端部执行器连接到所述控制手柄并绕一铰接轴线铰接;
所述缝合钉起动器的一部分穿过所述被动铰接接头并以与所述被动铰接接头的铰接相对应的方式挠曲;以及
所述绞接接头起动器:
当处于所述未起动状态时,连接到所述铰接锁,并因此将所述被动铰接接头锁定于给定的铰接位置,以将所述端部执行器保持在一定位置;以及
当处于所述起动状态时,与所述铰接锁断开连接,并因此铰接松开所述被动铰接接头,以根据施加于所述端部执行器的外力自由铰接。
6.根据权利要求5所述的医疗装置,其特征在于,所述铰接接头起动器当处于所述起动状态时与所述铰接锁断开连接,从而将所述被动铰接接头相对于所述控制手柄铰接松开。
7.根据权利要求5所述的医疗装置,其特征在于,所述铰接接头起动器当处于所述起动状态时与所述铰接锁断开连接,从而将所述被动铰接接头围绕所述铰接轴线铰接松开。
8.根据权利要求1所述的医疗装置,其特征在于,所述被动铰接接头的所述铰接轴线与所述纵向轴线正交。
9.根据权利要求5所述的医疗装置,其特征在于,所述被动铰接接头的所述铰接轴线与所述纵向轴线正交。
10.根据权利要求1所述的医疗装置,其特征在于:
所述手术吻合端部执行器具有带刀片的切割装置;
所述控制手柄的所述缝合钉起动器具有:
吻合器闭合起动器,当其起动时闭合所述抵钉座和所述缝合钉仓;和
吻合器击发起动器,当起动时吻合所述至少一个缝合钉并用切割装置切割;和
吻合器闭合起动器和吻合器击发起动器与铰接接头起动器不同。
11.根据权利要求5所述的医疗装置,其特征在于:
所述手术吻合端部执行器具有带有刀片的切割装置;
所述控制手柄的所述缝合钉起动器具有:
吻合器闭合起动器,当其起动时闭合所述抵钉座和所述缝合钉仓;和
吻合器击发起动器,当起动时吻合所述至少一个缝合钉并用切割装置切割;和
吻合器闭合起动器和吻合器击发起动器与铰接接头起动器不同。
12.一种医疗装置,包括:
控制手柄,该控制手柄具有:
缝合钉起动器;
拉动-释放和松开—再锁绞接接头起动器,该铰接接头起动器与所述缝合钉起动器不同且具有未起动状态和起动状态,在所述未起动状态中,所述铰接接头起动器处于静止,在所述起动状态中,所述铰接接头起动器沿着近端方向平移;和
本体,所述缝合钉起动器和所述铰接接头起动器横贯过该本体,所述本体限定一纵向轴线;
手术吻合端部执行器,该手术吻合端部执行器具有:
抵钉座;
缝合钉仓,具有至少一个缝合钉;
抵钉座-钉仓控制装置,其可操作地连接到所述缝合钉起动器、所述抵钉座、所述缝合钉仓,并在所述缝合钉起动器被起动时吻合所述至少一个缝合钉;和
铰接锁;
被动铰接接头,该被动铰接接头将所述吻合端部执行器连接到所述控制手柄并绕一铰接轴线铰接;
所述缝合钉起动器的一部分穿过所述被动铰接接头并以与所述被动铰接接头的铰接相对应的方式挠曲;以及
所述绞接接头起动器:
当在所述未起动状态下处于静止时,连接到所述铰接锁,并因此将所述被动铰接接头锁定于给定的铰接位置,以将所述端部执行器保持在一定位置;以及
当在所述起动状态下向近端平移时,与所述铰接锁断开连接,并因此铰接松开所述被动铰接接头,以根据施加于所述端部执行器的外力自由铰接。
13.一种医疗装置,包括:
控制手柄,该控制手柄具有:
缝合钉起动器;
用于解锁铰接的装置,该装置与所述缝合钉起动器不同且具有未锁定状态和锁定状态;和
本体,所述缝合钉起动器和所述铰接解锁装置横贯过该本体;手术吻合端部执行器,该手术吻合端部执行器具有:
抵钉座;
缝合钉仓,具有至少一个缝合钉;和
抵钉座-钉仓控制装置,其可操作地连接到所述缝合钉起动器、所述抵钉座、所述缝合钉仓,并在所述缝合钉起动器被起动时吻合所述至少一个缝合钉;
用于将所述吻合端部执行器相对于所述控制手柄被动铰接的装置;
所述缝合钉起动器的一部分穿过所述被动铰接装置并以与所述被动铰接装置的铰接相对应的方式挠曲;以及
所述绞接解锁装置:
当处于所述锁定状态时,将所述端部执行器保持在基本固定的铰接位置;以及
当处于所述解锁状态时,根据施加于所述端部执行器的外力将所述端部执行器松开至自由铰接状态。
14.一种用于将手术端部执行器控制组装件连接到控制手柄的方法,该方法包括:
使具有一纵向轴线的控制轴设置有远端执行器组装件,通过将起动部分沿着所述纵向轴线移位,所述远端执行器组装件至少部分地起动;
使所述控制轴设置有一近端手柄连接器,该近端手柄连接器具有一转动联接盘,该转动联接盘可操作地将所述控制轴围绕所述纵向轴线可转动地连接到控制手柄;以及
固定一端部执行器双功能控制装置:
转动地固定于所述控制轴的至少一部分,以联接所述双功能控制装置、所述控制轴、和所述端部执行器组装件围绕所述纵向轴线的转动;和
纵向地固定于所述起动部分,以联接所述双功能控制装置和所述起动部分相对于所述控制轴的纵向运动。
15.一种医疗装置端部执行器控制组装件,用于将端部执行器连接到控制手柄,所述控制组装件包括:
控制轴,该控制轴具有:
纵向轴线;和
手柄部分,该手柄部分可操作地将所述控制轴围绕所述纵向轴线可转动地连接到控制手柄;
被动铰接接头,该被动铰接接头可操作地将端部执行器连接到所述控制轴;和
可转动控制装置:
可转动地固定连接到所述控制轴的至少一部分,在所述控制装置被转动时,将所述控制轴围绕所述纵向轴线对应地转动;并且
纵向连接到所述铰接接头,在起动时,选择性地将所述铰接接头解锁。
16.根据权利要求15所述的装置,其特征在于:在沿着所述纵向轴线纵向移动时,所述控制装置被纵向固定连接到所述铰接接头,以选择性地解锁所述铰接接头。
17.一种医疗装置,包括:
控制手柄,该控制手柄具有带纵向轴线的控制轴,所述控制轴围绕所述纵向轴线可转动地连接到所述控制手柄;
手术端部执行器,该手术端部执行器采用被动铰接连接件来连接到所述控制手柄;和
控制装置:
可转动地固定连接到所述控制手柄的至少一部分,在所述控制装置转动时将所述控制轴对应地围绕所述纵向轴线转动;以及
纵向连接到所述被动铰接连接件,以选择性地解锁所述端部执行器的铰接。
18.根据权利要求17所述的装置,其特征在于:所述手术端部执行器采用所述铰接连接件连接到所述控制轴。
19.根据权利要求17所述的装置,其特征在于:当沿着所述纵向轴线纵向移动时,所述控制装置纵向固定连接到所述铰接连接件,以选择性地将所述端部执行器的铰接解锁。
20.根据权利要求17所述的装置,其特征在于:
所述端部执行器采用所述铰接连接件转动地固定连接到所述控制轴;以及
在所述控制装置被转动时,所述控制装置可操作地对应转动所述控制轴和所述端部执行器。
21.一种医疗装置,包括:
控制手柄,该控制手柄具有带一纵向轴线的控制轴,所述控制轴围绕所述纵向轴线转动地连接到所述控制手柄;
手术端部执行器,该手术端部执行器相对于所述控制轴被动铰接并通过所述控制轴连接到所述控制手柄;和
控制装置:
转动地固定连接到所述控制轴的一部分,在所述控制装置被转动时,将所述控制轴围绕所述纵向轴线对应转动;和
在起动时可操作地选择性解锁所述端部执行器的被动铰接。
22.根据权利要求21所述的装置,其特征在于:当相对于所述控制轴纵向移动时,所述控制装置可操作地选择性地解锁所述端部执行器的被动铰接。
23.根据权利要求21所述的装置,其特征在于:当所述控制装置转动时,所述控制装置可操作地将所述控制轴和所述端部执行器对应转动。
24.一种医疗装置,包括:
控制手柄,该控制手柄具有一被动铰接接头的带纵向轴线的第一部分,所述第一部分能够相对于所述控制手柄围绕所述纵向轴线转动;
手术端部执行器,该手术端部执行器具有所述被动铰接接头的第二部分并通过所述第一部分连接到所述控制手柄从而用于起动,所述被动铰接接头的所述第一和第二部分以被动铰接将所述端部执行器连接到所述控制手柄;和
控制装置:
转动地固定连接到所述第一部分的至少局部,当所述控制装置被转动时,将所述第一部分围绕所述纵向轴线对应转动;以及
纵向连接到所述被动铰接接头的至少局部,以选择性地解锁所述端部执行器的被动铰接。
25.根据权利要求24所述的装置,其特征在于:当相对于所述第一部分纵向移动时,所述控制装置可操作地将所述端部执行器的被动铰接选择性地解锁。
26.根据权利要求24所述的装置,其特征在于:
所述端部执行器采用所述被动铰接接头转动地固定连接到所述第一部分;
当所述控制装置被转动时,所述控制装置可操作地对应转动所述第一部分和所述端部执行器。
27.一种医疗装置,包括:
端部执行器控制手柄;
控制轴,该控制轴具有:
纵向轴线;和
手柄部分,该手柄部分将所述控制轴围绕所述纵向轴线可转动地连接到所述控制手柄;
手术端部执行器;
被动铰接接头,该被动铰接接头将所述端部执行器连接到所述控制轴;
铰接接头松脱件,当起动时解锁所述铰接接头并当未起动时锁定所述铰接接头;和
端部执行器控制装置:
旋转固定连接到所述控制轴的至少一部分,当所述控制装置被转动时,将所述控制轴围绕所述纵向轴线对应转动;以及
纵向连接到所述接头,当起动时,纵向连接到所述接头松脱件,以选择性地解锁所述铰接接头。
28.根据权利要求27所述的装置,其特征在于:
所述控制轴具有:
远端;
近端;和
手柄部分,该手柄部分将所述控制轴的所述近端围绕所述纵向轴线可转动地连接到所述控制手柄;
所述被动铰接接头将所述端部执行器连接到所述控制手柄的所述远端;以及
当沿着所述纵向轴线纵向移动时,所述控制装置纵向地固定连接到所述接头松脱件,以选择性地解锁所述铰接接头。
29.根据权利要求27所述的装置,其特征在于:所述控制轴是空心的,并且所述接头松脱件穿过所述控制轴。
30.根据权利要求27所述的装置,其特征在于:当所述控制装置被转动时,所述控制装置可操作地将所述控制轴和所述端部执行器围绕所述纵向轴线对应转动。
31.根据权利要求27所述的装置,其特征在于:所述被动铰接接头:
在所述铰接接头松脱件未起动时将所述端部执行器铰接保持在一定位置;和
在所述铰接接头松脱件起动时铰接松开所述端部执行器。
32.根据权利要求31所述的装置,其特征在于:所述铰接接头松脱件在起动时铰接松脱所述端部执行器至自由铰接。
33.根据权利要求27所述的装置,其特征在于:
所述铰接接头松脱件具有未起动状态和起动状态;
所述铰接接头具有锁定铰接状态和未锁定铰接状态;以及
所述铰接接头松脱件:
当从所述未起动状态变化到所述起动状态时,将所述铰接接头从所述锁定铰接状态变化到所述未锁定铰接状态;以及
当从所述起动状态变化到所述未起动状态时,将所述铰接接头从所述未锁定铰接状态变化到所述锁定铰接状态。
34.根据权利要求27所述的装置,其特征在于:所述铰接接头松脱件具有未起动状态和起动状态,并且当处于所述未起动状态时铰接松开所述被动铰接接头。
35.根据权利要求34所述的装置,其特征在于:所述端部执行器铰接于如下情况之时:
所述铰接接头松脱件被起动;以及
外力施加于所述端部执行器。
36.根据权利要求27所述的装置,其特征在于:当所述铰接接头被解锁时,所述端部执行器根据施加于所述端部执行器的外力自由铰接。
37.根据权利要求27所述的装置,其特征在于:
所述端部执行器是手术吻合端部执行器,具有带缝合钉的吻合装置和带刀片的切割装置;以及
所述控制手柄具有:
吻合器闭合起动器,当其起动时闭合所述吻合装置;和
击发起动器,当起动时:
采用所述吻合装置进行吻合;并且
采用所述切割装置进行切割;以及
所述吻合器闭合起动器和所述吻合器击发起动器与所述铰接接头松脱件不同。
38.根据权利要求37所述的医疗装置,进一步包括:
至少一个第一挠曲装置,其通过所述被动铰接接头将所述控制手柄连接到所述吻合器击发起动器;
至少一个第二挠曲装置,其通过所述被动铰接接头将所述端部执行器连接到所述控制手柄;和
所述至少一个第一挠曲装置和所述至少一个第二挠曲装置以与所述被动铰接接头的铰接相对应的方式挠曲。
39.根据权利要求37所述的医疗装置,其特征在于:
所述端部执行器控制手柄具有远端部分;和
所述端部执行器控制装置是钟形端部执行器控制装置,其限定一内部空间,该内部空间围绕所述端部执行器控制手柄的所述远端部分设置。
40.根据权利要求27所述的医疗装置,其特征在于:
所述控制轴具有第一纵向轴线;
所述端部执行器具有第二纵向轴线;
所述控制手柄、所述端部执行器、所述被动铰接接头中的至少一个具有对正装置;和
当所述铰接接头松脱件被起动时,所述对正装置可操作地使所述端部执行器偏离,以将所述第一和第二纵向轴线基本对正。
41.根据权利要求40所述的医疗装置,其特征在于:所述对正装置是中心偏离装置。
42.根据权利要求27所述的医疗装置,其特征在于:
所述铰接接头松脱件具有松脱齿;
所述被动铰接接头具有接头齿,当所述铰接接头松脱件未起动时,所述接头齿与所述松脱齿互锁;并且
当所述铰接接头松脱件起动时,所述接头齿与所述松脱齿分离以解锁所述被动铰接接头。
43.根据权利要求27所述的医疗装置,其特征在于:所述铰接接头松脱件是拉动-释放和松开—再锁定扳机组装件。
44.根据权利要求27所述的医疗装置,其特征在于:
所述接头松脱件是所述控制轴的所述部分;以及
所述端部执行器控制装置被转动固定地且纵向地连接到所述接头松脱件;
在所述控制装置被转动时将所述控制轴围绕所述纵向轴线对应转动;
在纵向起动时将所述铰接接头选择性地解锁。
45.在具有连接到控制手柄的端部执行器的医疗装置中,一种端部执行器控制组装件,包括:
控制轴,具有:
纵向轴线;和
手柄部分,该手柄部分将所述控制轴围绕所述纵向轴线可转动地连接到所述控制手柄;
被动铰接接头,其将端部执行器连接到所述控制轴;和
端部执行器控制装置:
当所述控制装置转动时,转动固定地连接到所述控制轴的至少一部分,以将所述控制轴围绕所述纵向轴线对应转动;以及
当起动时,纵向连接到所述铰接接头,以将所述铰接接头选择性解锁。
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US11/491,626 US8579176B2 (en) | 2005-07-26 | 2006-07-24 | Surgical stapling and cutting device and method for using the device |
CN200680035337XA CN101500498B (zh) | 2005-07-26 | 2006-07-25 | 手术吻合和切割装置及其使用方法 |
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WO2017063382A1 (zh) * | 2015-10-16 | 2017-04-20 | 逸思(苏州)医疗科技有限公司 | 一种执行器可弯转的外科器械 |
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