CN101574273A - 可变加压手术缝合钉装置 - Google Patents
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- 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
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- B25C5/02—Manually operated portable stapling tools; Hand-held power-operated stapling tools; Staple feeding devices therefor with provision for bending the ends of the staples on to the work
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- 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
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
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- 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
- A61B2017/07214—Stapler heads
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- 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
- 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
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
- A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
Abstract
本发明公开了一种手术缝合钉施加装置，其包括砧座部和钉仓部，其中钉仓部与砧座部能够从张开位置活动到夹紧位置以夹紧处于两者之间的组织。所述钉仓部具有多个固位槽。多个第一手术缝合钉和多个第二手术缝合钉布置在相应的固位槽内。多个第一手术缝合钉具有呈第一结构的第一后梁，而多个第二手术缝合钉具有呈第二结构的第二后梁。所述第一结构不同于所述第二结构。此外，当多个第一手术缝合钉成形时第一结构对组织施加第一压缩力，而当多个第二手术缝合钉成形时第二结构对组织施加第二压缩力，所述第二压缩力不同于所述第一压缩力。
Description
相关申请的交叉引用
本申请要求享有于2008年5月9日提交的序列号为61/051,911的美国临时专利申请的优先权和权益，其全部内容通过引用合并于此。
技术领域
本公开涉及一种手术缝合钉施加装置。本公开尤其涉及一种手术缝合钉钉仓，该手术缝合钉钉仓包括配置为对组织施加不同压缩力的多个手术缝合钉。
背景技术
本领域中已知有多种手术缝合装置，其中的一些专门适于用在各种手术程序中，包括但不限于端端吻合术、环形端端吻合术、开放式胃肠吻合术、内窥镜下胃肠吻合术和横向吻合术。可以使用在这些手术程序期间的装置的合适的例子可见于美国专利5,915,616；6,202,914；5,865,361和5,964,394中。
通常，手术缝合装置包括砧座，在使用期间该砧座接近缝合钉钉仓。砧座包括凹坑，这些凹坑与钉仓中限定的固位槽对准和/或对齐以实现成型，而缝合钉从钉仓中射出。某些手术缝合装置的缝合钉钉仓具有一排或多排缝合钉，这些缝合钉沿纵向刀槽的侧面或径向布置，所述纵向刀槽被配置为容纳刀具或其它切割元件，以使能够同时切割组织和将组织结合在一起。根据特定的手术缝合装置，各排缝合钉可以成直线形或非直线形排列，比如圆形、半圆形或者其它拱形结构。
本领域中已知有多种类型的手术缝合钉，包括但不限于整体式缝合钉(unitary fastener)和两件式缝合钉(two-part fastener)。整体式缝合钉通常包括一对钉腿，钉腿从后梁伸出，钉腿适于刺穿组织并且由后梁连接。该种缝合钉形成诸如“B”形结构的闭合结构。典型的，两件式缝合钉包括钉腿，该钉腿是带倒刺的并且由后梁连接，钉腿被接合并固定为通常位于砧座中的独立固定件上。使用时，两件式缝合钉被压进组织中，以便倒刺穿透组织并从另一侧穿出，在该另一侧倒刺然后固定于固定件上。固定件阻止两件式缝合钉从组织脱落。两件式缝合钉是不打算被松开或移除的。两件式缝合钉通常由生物可吸收材料制成。
在前面述及的每个手术程序中，组织起初被抓紧或夹紧在砧座和钉仓之间，以使各个缝合钉可从钉仓射出、穿过固位槽并强行穿过被夹紧的组织。然后，通过把缝合钉驱动到砧座上的凹坑中而形成缝合钉。
在这些手术程序中共同关心的问题是止血，或者阻止目标组织的出血。众所周知，通过增加施加到创口上的压力的量能够限制血液流动，从而缩短实现止血所需的时间。为此目的，传统的手术缝合装置一般在切割线附近施加两排或多排缝合钉以压缩周边组织以达到停止任何出血和将切割组织结合在一起的目的。每一个缝合钉通常对组织施加足以实现止血的压缩力，但是，如果施加了过大的压力，会导致不必要地减少切割线周围的组织的血液流动，因此，将组织结合在一起的压力过大会导致组织坏死水平的提高、创口愈合速率的减慢和/或更长的恢复期。
因此，提供一种能够在使周边组织中的血液流动最大以促进愈合的同时限制组织中的血液流动以实现止血的手术缝合装置，将是很有益的。另外，当将组织夹紧或压缩在砧座和钉仓之间时，组织的差异指的是组织的一部分比组织的其它部分厚，因此提供一种能够更好地适应不同厚度组织的缝合钉也是很有益处的。
发明内容
本公开针对的是手术缝合器械，其被配置为在使周边组织中的血液流动最大以促进愈合的同时，限制组织内的血液流动以实现止血和创口闭合。尤其是，本公开的实施例包括为了改变施加到周边组织上的压缩力而改变手术缝合钉的构造。更进一步地说，当手术缝合钉在组织内形成时，手术缝合钉的后梁中的凹部与手术缝合钉的钉腿协作以对周边组织施加压缩力，这里，不同的凹部与对周边组织施加的不同的压缩力相对应。
在此公开的用于手术器械的缝合钉组件包括钉仓部和砧座部，其中钉仓部与砧座部能够从张开位置活动到夹紧位置以夹紧处于两者之间的组织。钉仓部具有多个布置在其中的固位槽。另外，公开了多个第一手术缝合钉和多个第二手术缝合钉，其中每个手术缝合钉被布置在相应的固位槽内。
根据本公开的一个方案，手术缝合钉施加装置包括多个第一手术缝合钉和多个第二手术缝合钉，多个第一手术缝合钉具有呈第一结构的第一后梁，而多个第二手术缝合钉具有呈第二结构的第二后梁。根据该实施例，第一结构不同于第二结构。第一结构被配置为当多个第一手术缝合钉成形时其对组织施加第一压缩力，而第二结构被配置为当多个第二手术缝合钉成形时其对组织施加第二压缩力。根据该实施例，第二压缩力不同于第一压缩力。
在一个实施例中，当多个第一手术缝合钉成形时，布置在固位槽内的多个第一推进器可以在第一手术缝合钉的第一后梁中形成凹部以限定第一结构。另外，当多个第二手术缝合钉成形时，布置在固位槽内的多个第二推进器可以在第二手术缝合钉的第二后梁中形成第二凹部以限定第二结构。第一凹部可以不同于第二凹部。另外，随着砧座部和钉仓部从张开位置活动到夹紧位置，施加给周边组织的压力与相应的手术缝合钉中的凹部的尺寸相对应。此外，几乎在将手术缝合钉驱动到砧座部的同时，多个第一推进器和多个第二推进器在手术缝合钉的相应的后梁中形成相应的凹部。
根据本公开的另一个方案，手术缝合钉施加装置包括能够向远侧移动穿过钉仓部的致动滑块。该致动滑块可以包括至少一个凸轮楔块。另外，随着该致动滑块向远侧行进穿过钉仓，凸轮楔块能够驱动推进器以配置手术缝合钉并将手术缝合钉驱动到砧座部。
在本公开的另一个方案中，钉仓部包括纵向刀槽，该纵向刀槽允许切割器穿过其中沿纵向移动。钉仓部还可以包括位于纵向刀槽的第一侧的第一内排固位槽和第一外排固位槽，以及位于纵向刀槽的第二侧的第二内排固位槽和第二外排固位槽，其中每一个固位槽对准相应的推进器和手术缝合钉。另外，与第一外排和第二外排中的手术缝合钉相比，第一内排和第二内排中的手术缝合钉可以形成有更大的凹部。相应地，与外排手术缝合钉相比，内排缝合钉可以具有更小的内部空间。而且，因此，与外排手术缝合钉周围的组织相比，更大的力将施加到内排手术缝合钉周围的组织上。
在另一个实施例中，致动滑块可以包括第一内凸轮楔块、第二内凸轮楔块、第一外凸轮楔块和第二外凸轮楔块，其中，第一内凸轮楔块接触第一内排固位槽中的推进器，第二内凸轮楔块接触第二内排固位槽中的推进器。相应地，第一外凸轮楔块接触第一外排固位槽中的推进器，第二外凸轮楔块接触第二外排固位槽中的推进器。
附图说明
以下参考附图描述了本公开的一些实施例，其中：
图1是依照本公开一个实施例的包括手术缝合钉钉仓的手术缝合钉施加装置的远端部的俯视立体图；
图2是与图1的手术缝合钉钉仓一起使用的手术缝合钉在形成之前的一个实施例的侧视立体图，该手术缝合钉包括基本直线形的后梁；
图3a是第一手术缝合钉形成后在相邻组织部分中的剖面图；
图3b是第二手术缝合钉形成后的剖面图；
图3c是第三手术缝合钉形成后的剖面图；
图3d是第四手术缝合钉形成后的立体图；
图4是根据本公开的实施例的手术缝合装置的手术缝合钉钉仓的俯视图；
图5a是根据本公开的实施例的手术缝合装置的局部剖面图；
图5b是根据本公开的实施例的手术缝合装置的局部剖面图；
图5c是根据本公开的实施例的致动滑块的立体图；
图5d是根据本公开的实施例的推进器的立体图；
图6是根据本公开的实施例的手术缝合装置的致动结构的侧视立体图；
图7是用在腹腔镜检查手术程序中的根据本公开的实施例的手术缝合钉施加装置的立体图；
图8是根据本公开的实施例的手术缝合钉施加装置的立体图；
图9是根据本公开的实施例的手术缝合钉施加装置的立体图；
图10是根据本公开的实施例的手术缝合钉施加装置的钉仓的立体图；以及
图11是根据本公开的实施例的手术缝合钉施加装置的立体图。
具体实施方式
现在将参照附图详细说明本公开的手术缝合钉钉仓的各种示范实施例，其中相似的附图标记指代相似或相同的元件。在随后的附图和说明中，依照本领域中的传统和惯例，术语“近侧”指的是在使用中手术缝合钉钉仓较接近操作者的一端，而“远侧”指的是该缝合钉钉仓远离操作者的一端。另外，术语“手术缝合钉”应当被理解为包括由生物相容性材料制成的、适于将组织结合在一起的预期目的的任何基本刚性结构，包括但不限于手术吻合器、手术夹钳等。手术缝合钉可以由任何生物相容性金属制成，诸如钛或不锈钢或包括可吸收性或再吸收性聚合物的任何生物相容性聚合物。
参照图1和图7，讨论根据本公开的一个实施例的手术缝合钉施加装置1000。手术缝合钉施加装置1000用于对病人组织顺序施加多个手术缝合钉，例如手术缝合钉130，而且该装置1000的类型可以是可重复使用的或一次性的。手术缝合钉施加装置1000包括手柄1002、从手柄1002向远侧延伸的细长轴1004和与细长轴1004的远端1008相连接的手术工具1006(图7)。活动手柄1002将驱动杆向远侧推进以使手术工具1006运转。但是，也可以使用其它手柄，诸如马达驱动的、液压的、用棘轮驱动的等。通常，手术工具1006适用于将相邻组织部分夹紧、顺序缝合在一起并且沿切割线切断相邻组织部分。相应地，手术工具1006包括彼此枢轴连接的一对对置的钳口1010，1012，其中钳口1010和钳口1012分别包括砧座部件1014和手术缝合钉钉仓100。
在操作中，手术缝合钉施加装置1000类似于并依照其它已知的手术缝合器械而发射。关于手术缝合器械1000的接近及发射的详细讨论，可以参考目前转让给Tyco医疗健康集团的共有的美国专利5,865,361，该专利的全部内容将通过引用合并于此。手柄组件1002包括壳体1016，该壳体1016包括固定手柄部件1018。活动手柄1020可枢转地被支撑在壳体1016内并偏离固定手柄部件1018。活动手柄1020朝固定手柄部件1018方向的移动向壳体1016内的致动轴传递驱动力，导致致动轴向远侧方向直线推进。砧座部件1014和缝合钉钉仓100被移动的更靠近彼此，而且力被传递到发射器或推进器上，发射器或推进器的位置邻近于布置在缝合钉钉仓100的固位槽内的手术缝合钉130，从而发射手术缝合钉130并且将手术缝合钉130驱动到手术砧座部件1014的缝合钉成型面。
手术缝合钉钉仓100沿纵轴“A-A”延伸，其包括钉仓主体112，钉仓主体112具有一对侧壁114和116、底壁118及顶壁120(图1)。钉仓主体112包括纵向刀槽122，该纵向刀槽122被配置为容纳刀具(未显示)或其它切割元件的纵向移动以便能够沿切割线切断组织。顶壁120进一步包括组织接合面124和多个缝合钉固位槽126，接合面124例如用于接合待切割的组织，多个缝合钉固位槽126以基本沿钉仓100的全长分布的方式垂直或者大致横向于纵轴A-A排列。如图1所示，固位槽126的第一内排128A和固位槽的第一外排128B形成在纵向刀槽122的第一侧，而在纵向刀槽122的另一侧，钉仓100具有第二内排固位槽128C和第二外排固位槽128D。尽管钉仓100被描述为在纵向刀槽122的每一侧包括一对固位槽，但是，在钉仓100的另外的实施例中可以包括附加的多排缝合钉固位槽126。优选实施例中的钉仓100是可拆卸的和可由另一个加载钉仓替换的，或者形成可拆卸和可替换的装载单元的一部分。
每个缝合钉固位槽126被配置为在其中容纳多个手术缝合钉及推进器中的一个，以使在缝合期间将手术缝合钉成排配置在组织中产生的切割线的相对两侧上。图2示出了手术缝合钉的初始形状，或任何其它大致开放的结构。例如，手术缝合钉具有后梁和从该后梁大致垂直伸出的一对钉腿，诸如手术缝合钉130具有后梁134和钉腿132。可以改变后梁134和钉腿132的尺寸，以使手术缝合钉130可以用于缝合任意厚度的相邻组织部分“T1”，“T2”(见图3a)。
钉仓100包括向远侧平移穿过钉仓100的致动滑块1134。如图5a所示，该致动滑块1134由驱动杆1107向远侧驱动，而驱动杆1107通过手柄1002致动。滑块1134包括凸轮楔块，凸轮楔块与推进器1131接触并且向上驱动推进器1132以配置手术缝合钉130并将缝合钉驱动到砧座部件1014(图5c)。在某些实例中，钉仓100的致动滑块1134具有第一内楔1135、第二内楔1130、第一外楔1133和第二外楔1137。第一内楔1135接触缝合钉固位槽126的第一内排128A中的推进器，第二内楔接触固位槽126的第二内排128C中的推进器，第一外楔接触固位槽126的第一外排128B中的推进器，第二外楔接触固位槽126的第二外排128D中的推进器。如图5c所示，这些凸轮楔块1135彼此一体形成或者相互连接。
与第一及第二内排固位槽中的推进器接触的第一和第二内楔各自具有限定卷边楔形面(crimping wedge surface)的楔形面1135a和1135b和另一个造窝楔形面(dimpling wedge surface)1135c。卷边楔形面1135a和1135b布置在滑块1134的凸轮楔块上，使得其布置在造窝楔形凹面1135c的远侧。相应的推进器具有卷边推进子1132和造窝推进子1138，如图6所示，造窝推进子1138相对于卷边推进子1132是可以滑动的。随着滑块1134被驱动杆1107向远侧驱动，卷边楔形面首先接触卷边推进子1132，将手术缝合钉驱动到砧座部件1014。然后造窝楔形面1135c开始接触造窝推进子1138。如图3b和图5b所示，仍位于钉仓和砧座构件之间的手术缝合钉被造窝推进子1138接合，而且在手术缝合钉的后梁中形成凹部116。
如图6所示，造窝推进子1138可以形成为容纳在卷边推进子1132中的通道1132c中的杆件。造窝楔形面1135c可以形成在滑块1134的凸轮楔块的中间，而约束楔形面1135a和1135b位于造窝楔形面两侧。在其它实例中，卷边楔形面可以形成在凸轮楔块的一侧，而造窝楔形面形成在凸轮楔块的另一侧，而且对应的推进器相应地排列。
与第一及第二外排固位槽中的推进器接触的第一和第二外楔1133，1137各具有单个楔形面1139。第一和第二外楔的这些楔形面与相应的推进器相互作用。随着滑块1134被驱动杆1107向远侧驱动，楔形面接触相应的推进器，将手术缝合钉驱动到砧座构件1014。砧座部件具有定形状为使手术缝合钉变形为大致闭合的结构的凹部。例如，可以使手术缝合钉变形为图3a所示的B形结构、图3c所示的矩形结构或者任何其它结构。在这个实施例中，在钉仓100的外排固位槽内的手术缝合钉的后梁是没有凹陷的。在某些优选实施例中，期望内排固位槽的手术缝合钉比外排固位槽的手术缝合钉具有更小的内部空间，对组织压缩的程度更大。
在另外一个实施例中，手术缝合钉钉仓在内排固位槽中的每个推进器具有如图5d所示的一体形成的卷边推进子和造窝推进子。造窝推进子1201具有在卷边推进子1207的上表面1205的上方延伸的上表面1203。随着滑块向远侧行进穿过钉仓，推进器1200基本在同一时间使手术缝合钉闭合并在手术缝合钉的后梁中形成凹部。滑块的与这些推进器对应的楔子具有单个楔形面用以驱动推进器1200。外排固位槽内的推进器为以上讨论的推进器以形成呈不同成型结构的手术缝合钉。在某些实施例中，期望内排固位槽的手术缝合钉比外排固位槽的手术缝合钉具有更小的内部空间。手术缝合钉钉仓可以具有横向或大致垂直于钉仓的纵轴排列的固位槽，或者固位槽可以大致平行于钉仓的纵轴。
在另外一个实施例中，手术缝合钉钉仓的推进器具有折叠部。在手术缝合钉初始形成后，折叠部即断裂(fail)。这使得推进器的一部分继续被推进，这样在手术缝合钉的后梁的一部分中形成凹陷或凹部。
在其它一些实施例中，手柄可分别致动一个或多个凸轮楔块。比如，手柄可以包括各自与驱动杆相连接的一个以上的活动手柄臂。使用者可以操纵每个活动手柄臂以驱动与凸轮楔块之一接触的驱动杆。这样，就能够分别配置一排或者多排手术缝合钉。
在另一个实施例中，具有造窝推进子的推进器设置在一排手术缝合钉的远端，而该排中的剩余的推进器则不具有造窝推进子。与该排中剩余的缝合钉相比，在该排远端处的手术缝合钉具有包括凹部的成型结构，并且形成时的手术缝合钉可以比该排中剩余的缝合钉具有更小的内部空间。在其它实例中，具有造窝推进子的推进器设置在一排手术缝合钉的近端和/或中间区域，而该排剩余的推进器则不具有造窝推进子，从而形成与剩余手术缝合钉相比而具有凹部和相对较小的内部空间的一些手术缝合钉。
手术缝合钉的钉腿132和后梁134可以限定具有任何适当几何结构的横截面，包括但不限于矩形、椭圆形、正方形、三角形、梯形等。如图2所示，钉腿132和后梁134可以呈现同样的几何结构以使手术缝合钉130的横截面结构基本一致，或者可选地，钉腿132和后梁134可以呈现出不同的宽度或不同的几何结构，例如，钉腿132可以呈现出矩形横截面，而后梁134可以呈现出椭圆形横截面。
在手术缝合钉130形成之前，钉腿132从后梁134伸出以使钉腿132基本平行。在可选方案中，钉腿132可以不以平行排列从后梁伸出，即钉腿132可以从后梁134会聚或发散。本公开设想，手术缝合钉130也可以被配置为方向上偏离的缝合钉，诸如美国专利7,398,907中所描述的，该专利的全部内容通过引用合并于此。手术缝合钉可以由诸如不锈钢、钛或者可变形聚合体的可变形材料形成。
每个钉腿132终止于尖端136，尖端136被配置为刺穿组织，如组织部分“T1”，“T2”(见图3a)。钉腿132的尖端136可以逐渐变细，以利于刺穿组织部分“T1”，“T2”，或者可选地，尖端136可以不包括尖梢。在手术缝合钉130的各种实施例中，尖端136可以限定锥状或扁平表面，正如于2003年4月13日提交的序列号为11/444,761、公开号为20060291981的美国专利申请中描述的那样，该专利的全部内容通过引用合并于此。
在图2所示的手术缝合钉130的实施例中，后梁134为基本直线形结构，并且处于无形变状态。当在组织部分“T1”，“T2”中形成后，手术缝合钉130的钉腿132可以朝向彼此弯曲并且指向后梁，处于图3a所示的字母“B”形形状。钉腿132和后梁134协作以维持相邻组织部分“T1”，“T2”的接近并且对其施加压缩力“F”，该压缩力“F”对组织部分“T1”，“T2”施加压力，从而抑制了穿过手术缝合钉130周围的组织的血液流动并且促进止血。在形成后，缝合钉具有闭合结构，此时后梁134和钉腿132之间的内部空间限制了施加到组织部分“T1”，“T2”上的压力的量，以使穿过组织的血液流动没有被完全抑制。当形成后，手术缝合钉130限定了总高度“Hf”，总高度“Hf”为从后梁134到钉腿132的最外弧线的距离。
图3a、图3b、图3c和图3d示出了缝合钉的可选成型结构。根据本公开的钉仓和手术缝合装置使用可以形成一个或多个成型结构的组合的缝合钉。钉仓内各排手术缝合钉的成型结构可以不同，或者每一排内的手术缝合钉的成型结构也可以不同。通常，手术缝合装置包括致动机构以在某些手术缝合钉的后梁中形成一个或多个凹部，以使后梁基本成非直线形结构。如以下将进一步详细讨论的，当成型时，后梁的非直线形结构减小了成型的手术缝合钉的内部空间，并且进一步抑制了穿过缝合钉周围的组织的血液流动。还期望对由手术缝合装置结合的组织的某些部分施加比组织的其它部分更大的压力，或者根据手术缝合装置接合的组织的不同厚度施加不同的压力。
图3b所示的手术缝合钉具有形成在手术缝合钉的后梁上的单个凹部116或者隆起。相反地，图3c所示的手术缝合钉则没有凹部或隆起，并且其钉腿不具有图3a所示的弯曲的B形结构。图3d所示的手术缝合钉在手术缝合钉的后梁上具有两个凹部138A。致动机构将包括两个造窝推进子以与手术缝合钉的后梁接合。
参照图3d，其示出了处于成型状态的手术缝合钉130a。手术缝合钉130a包括形成在后梁134a上的凹部138a，凹部138a从后梁134a向内延伸，弯向钉腿132的尖端136并且限定了具有第一高度“H1”的凹部或隆起。当手术缝合钉130a在组织部分“T1”、“T2”内形成时，隆起/凹部138a与手术缝合钉130a的钉腿132协作以对组织部分施加压缩力。由手术缝合钉130a施加的压缩力大于由手术缝合钉130(图3a)施加的压缩力，因为当与手术缝合钉130中被组织部分“T1”、“T2”占据的压缩空间(图3a)相比时，在后梁134A和钉腿132之间限定的并且被组织部分“T1”、“T2”占据的内部空间或者压缩空间小于手术缝合钉130中的压缩空间。因此，由手术缝合钉130a施加到组织部分“T1”、“T2”上的压力更大，因而，当与穿过手术缝合钉130周围的组织的血液流动相比时，穿过手术缝合钉130a周围的组织的血液流动被更进一步地抑制了，从而更加促进止血。但是，凹部138a及被组织部分“T1”、“T2”占据的压缩空间的尺寸为使得血液流动不被完全抑制，从而防止任何不必要的组织坏死。当成型后，手术缝合钉130a可以限定总高度“Hf”，该高度“Hf”基本等于由缝合钉130限定的高度。
在另一个实例中，形成在缝合钉的后梁上的凹部或隆起可以变化以改变成型的缝合钉的内部空间或压缩空间，从而与由手术缝合装置结合的组织的其它部分相比，对某些部分压缩的程度更大。在一个实施例中，例如，手术缝合钉钉仓形成为：第一和第二外排固位槽中的手术缝合钉具有较小凹部，而第一和第二内排固位槽中的手术缝合钉具有相对较大的凹部。因此，当手术缝合钉形成在组织部分“T1”、“T2”内时，这些凹部与手术缝合钉的钉腿协作以对组织部分施加压缩力。由具有较大凹部的手术缝合钉施加的压缩力大于由具有较小凹部的手术缝合钉施加的压缩力，因为前者被组织部分“T1”、“T2”占据的压缩空间较小。当成型后，手术缝合钉限定了基本相等的总高度“Hp”。
在图1所示的实施例中，安装在钉仓主体112内的手术缝合钉排列为限定了一对内排缝合钉和一对外排缝合钉，所述一对内排缝合钉和一对外排缝合钉与形成在顶壁120中的相应的内外排缝合钉固位槽126对应。因此，在纵向刀槽122的相对两侧上，一对内排缝合钉与纵向刀槽122横向隔开，还在纵向刀槽122的相对两侧上，一对外排缝合钉与该对内排缝合钉横向隔开，以使当缝合时手术缝合钉被配置在组织中产生的切割线(未图示)的相对两侧。也就是说，带有凹部116的缝合钉(图3b)会提供更大的压缩力，因为在凹部的弧顶(顶点)与成型的钉腿的弧顶之间存在较短的距离，缝合钉具有较小的内部空间，而且在图示的实施例中这些缝合钉被设置在更靠近切割线的内排固位槽中。从钉腿的弧顶到后梁的距离较大的那些缝合钉则被设置在外排固位槽上。假如在这个实施例中使用三排缝合钉，那么具有最小内部空间的缝合钉(例如，诸如具有相对较大凹部的缝合钉)将被优选地放置在最靠近切割线的最内排固位槽中。通过设置多排缝合钉，随着你接近切割线这些缝合钉提供更大的组织压缩，将组织压缩地更邻近切割线。然而，需明确的是，除了上述配置，手术缝合钉还可以以其它布置放置在排中。而且，本公开设想使用此处公开的任一手术缝合钉，以使用仅具有单一成型结构的手术缝合钉例如手术缝合钉130，或者采用具有多种成型结构的手术缝合钉。
尽管手术缝合钉施加装置1000被描述为一种适于用在腹腔镜检查程序中的用于执行组织的手术吻合缝合的装置，但是应理解的是，手术缝合钉钉仓100也可以适于与任何用于对组织施加手术缝合钉的预期目的的手术器械一起使用。例如，手术缝合钉钉仓100可以适于与图8所示的端端吻合设备2000、图9所示的在开放式胃肠吻合缝合程序期间使用的手术缝合钉施加装置3000，或者下列美国专利中所讨论到的任一种手术缝合钉施加装置一起使用：6,045,560；5,964,394；5,894,979；5,878,937；5,915,616；5,836,503；5,865,361；5,862,972；5,817,109；5,797,538以及5,782,396；以上专利的全部内容将通过引用合并于此。
手术缝合装置3000包括钉仓容纳半部3002和砧座半部3004，钉仓容纳半部3002容纳多个手术缝合钉。半部3002和3004经由手柄3006和3008枢转地连接以在使用期间接近。随着半部3002和3004的接近，通过推进发射杆3012来向远侧驱动发射滑片，而使手术缝合钉施加装置3000发射。发射滑片的远侧移动将导致多个凸轮条接合与多个推进器相互作用的凸轮面，从而使多个手术缝合钉从钉仓容纳半部3002射出。这些手术缝合钉定位在导轨的两侧，该导轨引导刀具的纵向运动，从而沿切割线切断组织。
现在参照图10，在一个可选实施例中，公开了一种手术缝合钉钉仓200。手术缝合钉钉仓200与手术缝合钉钉仓100的类似之处在于手术缝合钉钉仓200包含有多排缝合钉，但它不具有被配置为容纳刀具或其它切割元件(尽管在可选实施例中可以设置刀具)的纵向刀槽122(图1)。与手术缝合钉钉仓100一样，手术缝合钉钉仓200在钉仓主体212的顶壁220上包括多个缝合钉固位槽226，这些固位槽226排列成多个行列228。中心线252沿由钉仓主体212限定的纵轴“A-A”延伸，固位槽226的行列228与中心线252横向隔开，优选地，行列228从侧壁214，216等距离隔开。如图所示，多个行列228包括布置在中心线252相对的两侧上的一对第一(内)行列228a和布置在中心线252相对的两侧上并与一对第一行列228a横向隔开的一对第二(外)行列228b。每个固位槽大致平行于纵轴延伸。每个缝合钉固位槽226被配置为容纳多个手术缝合钉及推进器(未显示)中的一个，以使手术缝合钉在中心线252相对的两侧上呈排配置，例如，呈图10的实施例的内外排，并且使手术缝合钉形成为具有一种或多种成型结构的缝合钉，如图3a、图3b、图3c、图3d所示的手术缝合钉。
图4示出了手术缝合钉钉仓2220的实例，该钉仓的上表面2222上形成有固位槽2224。固位槽大致垂直于纵轴延伸。这些固位槽2224排列成纵列，比如纵列2227和行列2228。该钉仓2220不包括用于刀具的纵向刀槽。如此处讨论的，钉仓2220包括多个推进器，用于使某些缝合钉形成相对较大的内部空间，而使其它缝合钉形成相对较小的内部空间。
尽管图10所示的手术缝合钉钉仓200被描述为包括一对第一行列228a和一对第二行列228b，但是就像前文在关于手术缝合钉钉仓100的讨论中述及的那样，在手术缝合钉钉仓200的一些可选实施例中也可以包括其它多排缝合钉固位槽226及相应地其它多排手术缝合钉，而且，如此处讨论的其它钉仓实施例，缝合钉可以在钉仓内排列为不同的形式。
另外参考图11，图11示出了与手术缝合钉钉仓200一起使用的可重复使用或一次性类型的手术缝合钉施加装置4000。手术缝合钉施加装置4000包括手柄组件4002、从手柄4002向远侧延伸的细长部4004以及从细长部4004的远端4008伸出的支臂4006。手术缝合钉施加装置4000还包括末端执行器4010，末端执行器4010包括砧座4012和手术缝合钉钉仓容纳器4014，砧座4012垂直固定在支臂4006上，手术缝合钉钉仓容纳器4014可操作地连接在细长部4004的远端4008用于将手术缝合钉钉仓200保持在远端4008上。
在操作中，手术缝合钉施加装置4000类似于并依照其它已知的手术缝合器械而发射。关于手术缝合器械4000的接近及发射的详细讨论，可参考目前转让给Tyco健康医疗集团的共有的美国公开专利5,964,394，该专利的全部内容通过引用合并于此。手柄组件4002包括壳体4016，该壳体4016包括固定手柄部件4018。活动手柄4020可枢转地被支撑在壳体4016内并偏离固定手柄部件4018。活动手柄部件4020朝固定手柄部件4018方向的移动向壳体4016内的致动轴传递驱动力，依次将力传递到缝合钉钉仓4014内的推动条，从而发射布置在缝合钉钉仓200的固位槽内的缝合钉并且将手术缝合钉驱动到砧座部件4012的缝合钉成型面。在将缝合钉钉仓4014推向砧座4012之前，医生将接近杆4017移向壳体4016，这导致在发射缝合钉和使缝合钉钉仓4014接近砧座4012及置于两者之间的组织之前，缝合钉钉仓4014移向砧座4012。
手术缝合钉施加装置4000用于施加多个手术缝合钉例如手术缝合钉130到目标组织切片(未显示)的任一侧，其可以是任何适于该预期目的的手术缝合钉施加装置，包括但不限于美国专利7,070,083公开的横向吻合缝合器械，该专利的全部内容已通过引用合并在前面的说明中。缝合钉施加装置具有多个推进器，这些推进器被朝远侧方向推进以在远侧方向上从钉仓将手术缝合钉配置到砧座。缝合钉的配置和形成大致同时发生。为了使某些手术缝合钉形成与钉仓内的其它缝合钉不同的结构(例如，图3a、图3b、图3c、图3d所显示的)，有些推进器具有造窝推进子和卷边推进子。造窝推进子和卷边推进子可以是相对于彼此可活动的，以分别将缝合钉闭合然后在手术缝合钉的后梁中形成凹部；或者造窝推进子和闭合推进子可以彼此一体形成。此后，可以使用解剖刀或其它切割元件除去目标组织切片。有关手术缝合钉施加装置4000的使用和功能的更详细的介绍可通过参考美国专利7,070,083而获得。在可选实施例中，就像在此公开的其它钉仓一样，装置4000也可以包括切割元件。
根据本公开的某些实施例的手术缝合钉施加装置包括多个凸轮条，这些凸轮条用于与推进器相互作用以配置手术缝合钉。例如，在美国专利5,318,221中公开的装置具有保持多个凸轮条和刀具的凸轮条接合器，该专利的全部内容通过引用合并于此。通过操作装置的手柄来推进通道，从而将凸轮条和刀具向前驱动。环绕砧座的近端的夹紧管被推进从而使砧座和钉仓夹拢在一起。在另外一个实例中，由美国专利5,782,396公开的装置具有致动滑块，该专利的全部内容通过引用合并于此。在这个装置中，通过操作装置的手柄将细长驱动梁向远侧推进，向前驱动致动滑块。随着驱动梁向远侧行进，驱动梁的远端接合砧座及支撑钉仓的通道，从而配置缝合钉和使砧座和钉仓夹拢在一起。
本公开设想了一种具有手术缝合钉钉仓的手术缝合装置，其具有一个手术缝合钉钉仓，该手术缝合钉钉仓的上表面限定了多个固位槽，这些固位槽排列成第一内排和第一外排，第一内排中的每一个固位槽包含第一内排手术缝合钉和第一内排推进器，第一内排推进器具有设置的卷边推进子和造窝推进子以形成呈第一闭合结构的第一内排手术缝合钉和在手术缝合钉的后梁中形成凹部，第一外排中的每一个固位槽包含第一外排手术缝合钉和第一外排推进器，第一外排推进器设置为形成呈第二成型结构的第一外排手术缝合钉。
本公开还设想了一种具有手术缝合钉钉仓的手术缝合装置，该手术缝合钉钉仓的上表面限定了多个固位槽，这些固位槽排列成第一内排和第一外排，第一内排中的每一个固位槽包含第一内排手术缝合钉和第一内排推进器，第一内排推进器设置为形成第一内排手术缝合钉，以使成型后的第一内排手术缝合钉具有第一内部空间和变形的后梁。第一外排中的每一个固位槽包含第一外排手术缝合钉和第一外排推进器，第一外排推进器设置为形成第一外排手术缝合钉，以使成型后的第一外排手术缝合钉具有第二内部空间，且第二内部空间大于第一内部空间。
应该理解的是，本公开并不限于上述特定实施例，本领域的普通技术人员可以做出不超出本公开的范围或精神的各种其它改变和变形。例如，上述手术缝合钉可以由许多外科手术上可接受的材料形成，包括钛、塑胶、生物可吸收材料等等。尽管此处已经结合附图描述了本公开的示意实施例，但是上述说明、公开及附图不应当被理解为是对本发明的限制，而仅是各种实施例的范例。
Claims (11)
1、一种手术缝合钉施加装置，包括：
缝合钉组件，其包括砧座部和钉仓部，所述钉仓部与所述砧座部能够从张开位置活动到夹紧位置以夹紧处于两者之间的组织，所述钉仓部具有多个固位槽；
多个第一手术缝合钉和多个第二手术缝合钉，每个手术缝合钉被布置在相应的固位槽内，所述多个第一手术缝合钉具有呈第一结构的第一后梁，而所述多个第二手术缝合钉具有呈第二结构的第二后梁，其中所述第一结构不同于所述第二结构，其中当所述多个第一手术缝合钉成形时所述第一结构对组织施加第一压缩力，而当所述多个第二手术缝合钉成形时所述第二结构对组织施加第二压缩力，所述第二压缩力不同于所述第一压缩力。
2、根据权利要求1所述的手术缝合钉施加装置，其中随着所述多个第一手术缝合钉成形，布置在所述固位槽内的多个第一推进器在所述第一手术缝合钉的第一后梁中形成第一凹部以限定第一结构，而随着所述多个第二手术缝合钉成形，布置在固位槽内的多个第二推进器在所述第二手术缝合钉的第二后梁中形成第二凹部以限定第二结构。
3、根据权利要求2所述的手术缝合钉施加装置，其中所述第一凹部不同于所述第二凹部。
4、根据权利要求2所述的手术缝合钉施加装置，其中随着所述砧座部和钉仓部从张开位置活动到夹紧位置，施加给周边组织的压力与手术缝合钉的后梁中的凹部的尺寸相对应。
5、根据权利要求2所述的手术缝合钉施加装置，其中几乎在将手术缝合钉驱动到所述砧座部的同时，所述多个第一推进器和多个第二推进器在手术缝合钉的相应的后梁中形成相应的凹部。
6、根据权利要求1所述的手术缝合钉施加装置，进一步包括能够向远侧移动穿过所述钉仓部的致动滑块，所述致动滑块包括至少一个凸轮楔块。
7、根据权利要求6所述的手术缝合钉施加装置，其中随着致动滑块向远侧行进穿过钉仓，所述至少一个凸轮楔块驱动推进器以配置手术缝合钉并将手术缝合钉驱动到所述砧座部。
8、根据权利要求1所述的手术缝合钉施加装置，其中所述钉仓部包括纵向刀槽，所述纵向刀槽配置为允许切割器穿过其中沿纵向移动。
9、根据权利要求8所述的手术缝合钉施加装置，其中所述钉仓部包括位于纵向刀槽的第一侧的第一内排固位槽和第一外排固位槽，以及位于纵向刀槽的第二侧的第二内排固位槽和第二外排固位槽，其中每一个固位槽对准相应的推进器和手术缝合钉。
10、根据权利要求9所述的手术缝合钉施加装置，其中第一内排和第二内排中的手术缝合钉被形成为比第一外排和第二外排中的手术缝合钉具有更大的凹部，以使与外排中的手术缝合钉相比，内排的手术缝合钉具有更小的内部空间，从而对组织施加更大的力。
11、根据权利要求9所述的手术缝合钉施加装置，其中所述致动滑块包括第一内凸轮楔块、第二内凸轮楔块、第一外凸轮楔块和第二外凸轮楔块，其中，第一内凸轮楔块接触第一内排固位槽中的推进器，第二内凸轮楔块接触第二内排固位槽中的推进器，第一外凸轮楔块接触第一外排固位槽中的推进器，第二外凸轮楔块接触第二外排固位槽中的推进器。
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2009
- 2009-04-03 US US12/417,709 patent/US8186556B2/en active Active
- 2009-04-28 AU AU2009201688A patent/AU2009201688B2/en not_active Ceased
- 2009-04-29 EP EP11005121.6A patent/EP2371296B1/en active Active
- 2009-04-29 ES ES11005121.6T patent/ES2589805T3/es active Active
- 2009-04-29 EP EP09251224.3A patent/EP2116192B1/en not_active Not-in-force
- 2009-04-29 ES ES09251224.3T patent/ES2622869T3/es active Active
- 2009-04-29 CA CA2664874A patent/CA2664874C/en not_active Expired - Fee Related
- 2009-05-07 JP JP2009113091A patent/JP5431015B2/ja not_active Expired - Fee Related
- 2009-05-08 CN CN2009101364292A patent/CN101574273B/zh active Active
- 2009-05-08 CN CN201310235090.8A patent/CN103371859B/zh active Active
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- 2012-05-07 US US13/465,251 patent/US8342380B2/en active Active
- 2012-11-30 US US13/690,339 patent/US9113870B2/en active Active
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- 2013-09-18 JP JP2013192614A patent/JP5729781B2/ja active Active
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- 2014-09-16 AU AU2014227435A patent/AU2014227435B2/en not_active Ceased
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN103153206A (zh) * | 2010-09-30 | 2013-06-12 | 伊西康内外科公司 | 支撑非线性排列缝钉的外科钉仓以及具有共用缝钉成形凹坑的外科缝合器械 |
| CN103356253A (zh) * | 2010-09-30 | 2013-10-23 | 伊西康内外科公司 | 具有不均匀排列的可植入的紧固件仓 |
| CN104334098A (zh) * | 2012-03-28 | 2015-02-04 | 伊西康内外科公司 | 包括限定低压强环境的胶囊剂的组织厚度补偿件 |
| CN104334098B (zh) * | 2012-03-28 | 2017-03-22 | 伊西康内外科公司 | 包括限定低压强环境的胶囊剂的组织厚度补偿件 |
| CN106028963A (zh) * | 2013-12-23 | 2016-10-12 | 伊西康内外科有限责任公司 | 外科钉和钉仓 |
| CN106028963B (zh) * | 2013-12-23 | 2019-04-05 | 伊西康内外科有限责任公司 | 外科钉和钉仓 |
| CN108289668A (zh) * | 2014-09-26 | 2018-07-17 | 伊西康有限责任公司 | 用于产生柔性钉线的紧固件仓 |
| CN108289668B (zh) * | 2014-09-26 | 2020-12-22 | 伊西康有限责任公司 | 用于产生柔性钉线的紧固件仓 |
Also Published As
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|---|---|
| AU2014227435A1 (en) | 2014-10-02 |
| EP2371296B1 (en) | 2016-08-10 |
| EP2371296A1 (en) | 2011-10-05 |
| AU2009201688B2 (en) | 2014-06-26 |
| CA2664874C (en) | 2016-09-20 |
| ES2589805T3 (es) | 2016-11-16 |
| CA2664874A1 (en) | 2009-11-09 |
| US8186556B2 (en) | 2012-05-29 |
| JP2009268909A (ja) | 2009-11-19 |
| US9113870B2 (en) | 2015-08-25 |
| US8342380B2 (en) | 2013-01-01 |
| EP2116192A1 (en) | 2009-11-11 |
| AU2009201688A1 (en) | 2009-11-26 |
| US20090281554A1 (en) | 2009-11-12 |
| JP5729781B2 (ja) | 2015-06-03 |
| JP2014054544A (ja) | 2014-03-27 |
| US20120228359A1 (en) | 2012-09-13 |
| JP2015071042A (ja) | 2015-04-16 |
| CN103371859A (zh) | 2013-10-30 |
| AU2014227435B2 (en) | 2015-09-17 |
| CN101574273B (zh) | 2013-07-17 |
| CN103371859B (zh) | 2015-01-14 |
| ES2622869T3 (es) | 2017-07-07 |
| JP5431015B2 (ja) | 2014-03-05 |
| US20130087603A1 (en) | 2013-04-11 |
| EP2116192B1 (en) | 2017-03-22 |
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