CN104736069A - 外科切割器械 - Google Patents
外科切割器械 Download PDFInfo
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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
- 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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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
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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
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B17/32075—Pullback cutting; combined forward and pullback cutting, e.g. with cutters at both sides of the plaque
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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
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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
- A61B2017/07285—Stapler heads characterised by its cutter
Abstract
一种外科切割器械(100)包括第一钳口构件(108)、第二钳口构件(110)和切割构件(122)，该第二钳口构件(110)能够相对于第一钳口构件运动地支撑以在打开位置和闭合位置之间选择性地运动，以在对其施加闭合运动时将组织夹持在所述第一钳口构件和所述第二钳口构件之间，该切割构件(122)包括组织切割刃(13)以在对切割构件施加回缩运动时切割被夹持在第一钳口构件和第二钳口构件之间的组织。
Description
背景技术
本公开总体涉及外科，并且具体地涉及外科横断或切割工具，所述横断或切割工具单独地或作为外科组织切割和紧固器械的一部分被用于切割组织。
在许多外科手术过程中，常见的是使用组织紧固和切割装置诸如线性切割器以用于紧固和横断组织，以便切除组织并通过将多个侧向间隔开的钉排放置在组织切口或组织横断线的相对侧上来实现止血。外科紧固和切割器械大体被用于在组织中制造纵向切口，并且将钉排施加在所述切口的相对侧上。此类器械常常包括具有一对协同工作的钳口构件的端部执行器。在所述器械旨在用于内窥镜式或腹腔镜式应用时，所述一对协同工作的钳口构件能够穿过管道通道。所述钳口构件中的一者接收钉仓，所述钉仓具有横向间隔开的至少两排钉。另一钳口构件限定砧座，所述砧座具有与所述仓中的钉排对准的钉成形凹坑。器械包括多个往复式楔形件，当朝远侧驱动所述多个往复式楔形件时，所述多个往复式楔形件穿过钉仓中的开口并接合支撑钉的驱动器，以实现朝着砧座击发钉。切割器械被沿着所述钳口构件超远侧拖曳，使得夹持的组织被切割和紧固(例如，用钉钉住)。
适于内窥镜式应用的外科紧固和切割工具的一个示例描述于2006年2月21日公布的名称为“SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS”的美国专利7,000,818中，所述专利的全部公开内容以引用的方式并入本文。在使用中，临床医生能够将器械的钳口构件闭合在组织上以在激发之前定位组织。一旦临床医生已经确定所述钳口构件已经适当抓持组织，临床医生然后可击发所述外科器械，从而切断和缝合组织。马达驱动的外科紧固和切割器械描述于2008年8月26日公布的名称为“MOTOR-DRIVEN SURGICAL CUTTINGAND FASTENING INSTRUMENT WITH LOADING FORCE FEEDBACK”的美国专利7,416,101中，所述专利的全部公开内容以引用的方式并入本文。
附图说明
本发明的各种实施例的新颖特征在随附权利要求书中会特别阐述。然而，结合附图参照下述说明可最佳地理解关于手术的组织和方法两者的本发明的各种实施例、连同其另外的目的和优点。
图1为包括柄部、轴和端部执行器的外科切割器械的透视图；
图2为图1的外科切割器械的端部执行器的下钳口；
图3为图1的外科切割器械的端部执行器的下钳口的局部分解图；
图4为图1的外科切割器械的端部执行器的下钳口的局部剖视图；
图5为图1的外科切割器械的端部执行器的下钳口的局部剖视图；
图6为图1的外科切割器械的端部执行器的下钳口的局部剖视图；
图7为图1的外科切割器械的端部执行器的下钳口的局部剖视图；
图8为图1的外科切割器械的靠近组织的端部执行器的透视图；
图9为图1的外科切割器械的夹持组织的端部执行器的透视图；
图10为图1的外科切割器械的夹持组织的端部执行器的透视图，并且切割构件切穿组织；
图11为由图1的外科切割器械切割的组织的透视图；
图12为包括柄部、轴和端部执行器的外科切割器械的透视图；
图13为图12的外科切割器械的端部执行器的下钳口的透视图；
图14为图12的外科切割器械的端部执行器的下钳口的局部分解图；
图15为图12的外科切割器械的端部执行器的下钳口的局部剖视图；
图16为图12的外科切割器械的端部执行器的下钳口的局部剖视图；
图17为图12的外科切割器械的端部执行器的下钳口的局部剖视图；
图18为图12的外科切割器械的端部执行器的下钳口的局部剖视图；
图19为包括柄部、轴和端部执行器的外科切割器械的透视图；
图20为图19的外科切割器械的端部执行器的下钳口的透视图，显示部署的切割构件；
图21包括图19的外科切割器械的驱动构件的两个局部透视图，其中实线中的图示出未部署的切割构件；并且虚线中的图示出部署的切割构件；
图22为图19的外科切割器械的驱动构件的局部剖视图；
图23为图19的外科切割器械的驱动构件的局部剖视图；
图24为图19的外科切割器械的驱动构件的局部剖视图；
图25为包括柄部、轴和端部执行器的外科切割和紧固器械的透视图；
图26为图25的外科器械的端部执行器的钉仓的局部分解透视图；
图27为图26的钉仓和图25的外科器械的驱动构件的局部剖视图；
图28为图26的钉仓的局部剖视图，示出未部署的切割构件；
图29为图26的钉仓的局部剖视图，示出未部署的切割构件；
图30为图26的钉仓的局部剖视图，示出部署的切割构件；
图31为图26的钉仓的局部剖视图，示出部署的切割构件；
图32为图25的外科器械的端部执行器的钉仓的局部分解透视图；
图33为图32的钉仓的局部剖视图，示出未部署的切割构件；
图34为图32的钉仓的局部剖视图，示出未部署的切割构件；
图35为图32的钉仓的局部剖视图，示出部署的切割构件；
图36为图32的钉仓的局部剖视图，示出部署的切割构件。
发明内容
外科切割器械可包括第一钳口构件、第二钳口构件和切割构件，所述第二钳口构件相对于所述第一钳口构件运动地支撑以在打开位置和闭合位置之间选择性地运动，以在对其施加闭合运动时将组织夹持在所述第一钳口构件和所述第二钳口构件之间；所述切割构件包括组织切割刃，以在对所述切割构件施加回缩运动时切割被夹持在所述第一钳口构件和所述第二钳口构件之间的组织。
与外科缝合器一起使用的外科钉仓组件包括能够操作地支撑在所述外科缝合器中的钉仓外壳，其中所述钉仓外壳可包括顶部表面、狭槽和至少一个钉腔。所述钉仓组件可还包括定位在所述钉仓外壳内的切割构件，所述切割构件包括能够切割组织的组织切割刃，其中所述切割构件能够在对其施加回缩运动时朝近侧回缩，并且其中当所述切割构件朝近侧回缩穿过所述组织时所述组织切割刃朝近侧呈现。
外科切割和紧固器械可包括细长轴、能够操作地联接到所述细长轴并且能够操作地在其中支撑钉仓的细长通道、以及相对于所述细长通道运动地支撑以在打开位置和闭合位置之间选择性地运动的砧座，其中响应于从所述细长轴施加到所述细长通道的打开运动和闭合运动，组织被夹持在所述砧座和被支撑在所述细长通道内的钉仓之间。所述外科器械可还包括具有组织切割刃的切割构件，其中所述切割构件能够相对于所述细长通道回缩，并且其中在所述切割构件的回缩期间所述组织切割刃能够切割夹持在所述砧座和所述钉仓之间的组织。
外科切割和紧固器械包括第一钳口、第二钳口和包括组织切割刃的切割构件，所述第一钳口包括具有顶部表面的外壳，所述第二钳口能够相对于所述第一钳口在对其施加打开运动和闭合运动时运动地支撑，所述切割构件能够在对其施加击发运动时从近侧起始位置运动到远侧结束位置，并在对其施加回缩运动时从所述远侧结束位置运动到所述近侧起始位置，所述切割构件还能够运动地支撑在所述第一钳口的外壳内，使得当所述切割构件从所述近侧起始位置运动到所述远侧结束位置时所述组织切割刃定位在所述第一钳口的外壳的顶部表面的下方，并且当所述切割构件从所述远侧结束位置运动到所述近侧起始位置时所述组织切割刃在所述第一钳口的外壳的顶部表面的上方延伸。
外科钉仓包括具有顶部表面的仓外壳和切割构件，所述仓外壳能够操作地在其中支撑多个外科钉，所述切割构件能够运动地支撑在所述仓外壳内并包括组织切割刃，所述切割构件能够从近侧起始位置运动到远侧结束位置，并且能够从所述远侧结束位置运动到所述近侧起始位置，所述切割构件还能够运动地支撑在所述仓外壳内，使得当所述切割构件从所述近侧起始位置运动到所述远侧结束位置时所述组织切割刃定位在所述第一钳口的外壳的顶部表面的下方，并且当所述切割构件从所述远侧结束位置运动到所述近侧起始位置时所述组织切割刃在所述第一钳口的外壳的顶部表面的上方延伸。
具体实施方式
如本文通常所用，术语“近侧”和“远侧”通常涉及临床医生操纵用于治疗患者的器械的一个端部。术语“近侧”通常是指器械的最靠近临床医生的部分。术语“远侧”通常是指离临床医生最远定位的部分。还应当理解，为简明和清楚起见，本文可以参考所示实施例使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而，外科器械可在多个方向和位置中使用，并且这些术语并不旨在限制性和绝对性的目的。
参见图1，大体为100的外科器械可包括柄部102、轴104和端部执行器106。在至少一个实施例中，如图1所示，端部执行器106可包括第一钳口构件108和第二钳口构件110。端部执行器106能够响应于对其施加的驱动运动来执行外科活动。第一钳口构件108能够相对于第二钳口构件110在第一位置和第二位置之间运动。第一位置可为打开位置并且第二位置可为闭合位置。在至少一个实施例中，参见图1，第一钳口构件108可枢转地联接到第二钳口构件110。在本公开的范围内设想了用于联接第一钳口构件108和第二钳口构件110的其它合适的布置结构。
再次参见图1，柄部102可包括闭合致动器112、击发致动器113和旋转致动器114。闭合致动器112可被枢转地联接到柄部102。闭合致动器112的致动可致使第一钳口构件108相对于第二钳口构件110运动。旋转所述旋转致动器114可导致端部执行器106围绕纵向轴线L-L旋转。
参见图2至图7，第二钳口构件110可包括具有顶部表面118的外壳116，所述顶部表面118具有沿着所述纵向轴线L-L延伸的狭槽120。如图2所示，外壳116可包括可沿着所述纵向轴线L-L行进穿过狭槽120的切割构件122。如在图3中的分解图中所示，外壳116可包括第一轨道124和第二轨道126。轨道124和轨道126可沿着纵向轴线L-L延伸使得它们彼此平行。此外，轨道124和轨道126可在基本上垂直于顶部表面118的平面内延伸，在该平面中，在至少一个实施例中，第二轨道126比第一轨道124更靠近顶部表面118。第一轨道124的远侧部分128可会聚以与第二轨道126相交于接合点130。轨道124和轨道126可还朝远侧延伸超出形成共同轨道部分132的接合点130。
再次参见图2至图7，切割构件122可包括组织切割刃134、第一销136、第二销138和接合部分140。切割构件122可在如图4所示的近侧起始位置142和如图6所示的远侧结束位置144之间行进。在近侧起始位置142处，第一销136可跨置在第一轨道124中，并且第二销138可跨置第二轨道126中，致使切割构件122保持在“未部署”取向中。如图4所示，在所述未部署取向中，组织切割刃134未被暴露在顶部表面118上方。
如在图3中的分解图所示，外科器械100可还包括驱动构件146，所述驱动构件可包括回缩钩148和驱动尖端150。驱动构件146在其近侧部分处能够操作地联接到击发致动器113，使得外科器械100的操作者可通过朝远侧推进击发致动器113来朝远侧推进驱动构件146，并且可通过朝近侧回缩击发致动器113来朝近侧回缩驱动构件146。
参见图4和图5，朝远侧推进驱动构件146可使驱动尖端150与切割构件122的接合部分140配合接合。在第一销136跨置在第一轨道124中并且第二销138跨置在第二轨道126中的情况下，如图5所示，进一步推进驱动构件146可使切割构件122从近侧起始位置142朝远侧行进穿过狭槽120。
参见图5和图6，可沿着轨道124和轨道126将处于未部署取向的切割构件122朝远侧推进，直到第一销136进入第一轨道124的远侧部分128为止。远侧部分128可包括凸轮表面152，当切割构件122继续朝远侧推进时，所述凸轮表面可致使第一销136朝接合点130提升。因此，切割构件122逐渐地从如图5所示的未部署取向转变到如图6所示的部署取向，在未部署取向中，组织切割刃134未被暴露在顶部表面118上方，在部署取向中，组织切割刃134被暴露在顶部表面118上方。换句话讲，推进第一销136抵靠凸轮表面152可致使切割构件122围绕横向于纵向轴线L-L的轴线运动，导致组织切割刃134的部署。
再次参见图5和图6，如上所述，当切割构件122从未部署取向转变到部署取向时，第一销136可进入共同轨道部分132。此外，切割构件122的接合部分140可脱离与驱动尖端150的配合接合，并且可与回缩钩148形成配合接合，如图6所示。
现在参见图6和图7，部署的切割构件122然后可响应于通过驱动构件146的回缩运动从远侧结束位置144朝近侧起始位置142朝近侧行进。如图6所示，组织切割刃134在远侧结束位置144处朝近侧呈现。驱动构件146的回缩可致使切割构件122沿着纵向轴线L-L朝近侧行进。当切割构件122开始朝近侧行进时，第一销136跨置在共同轨道部分132中，并且所述第二销138跨置在共同轨道部分126中。在到达接合点130时，第一销136被阻止通过驱动构件146再次进入第一轨道124的远侧部分128中。相反，第一销136进入第二轨道126。如图7所示，销136和销138两者可跨置在第二轨道126中以用于切割构件122的近侧行进的其余部分。
在某些实施例中，第一钳口构件108可包括与第二钳口构件110中的狭槽120对应的狭槽(未示出)。第一钳口构件108的狭槽也可沿着纵向轴线L-L延伸，并且可在切割构件122回缩穿过狭槽120期间接收部署的切割构件122的暴露在顶部表面118上方的区段的顶部部分。
现在参见图8至图11，外科器械100可用于执行外科组织横断手术。如图9所示，操作者可致动柄部102的闭合致动器112，以将组织抓持并固定在第一钳口构件108和第二钳口构件110之间。如上文所述，操作者然后可通过推进击发致动器113来部署切割构件122。在部署时，切割构件122可通过回缩击发致动器113而被回缩。当切割构件122朝近侧回缩时，朝近侧呈现的组织切割刃134可切穿被抓持在钳口构件108和钳口构件110之间的组织。然后可通过致动闭合致动器112来打开钳口构件108和钳口构件110使切断的组织从端部执行器106释放。
参见图12，大体为200的外科器械可包括柄部202、轴204和端部执行器206。在至少一个实施例中，如图12所示，端部执行器206可包括第一钳口构件208和第二钳口构件210。端部执行器206能够响应于施加至其的驱动运动来执行外科活动。第一钳口构件208可相对于第二钳口构件210在第一位置和第二位置之间运动。第一位置可为打开位置并且第二位置可为闭合位置。在至少一个实施例中，参见图12，第一钳口构件208可枢转地联接到第二钳口构件210。在本公开的范围内设想了用于联接第一钳口构件208和第二钳口构件210的其他合适的布置结构。
再次参见图12，柄部202可包括闭合致动器212、击发致动器213和旋转致动器214。闭合致动器212可枢转地联接到柄部202。闭合致动器212的致动可致使第一钳口构件208相对于第二钳口构件210运动。使旋转致动器214旋转可导致端部执行器206围绕纵向轴线L-L旋转。
参见图13至图18，第二钳口构件210可包括具有顶部表面218的外壳216，所述顶部表面具有沿着纵向轴线L-L延伸的狭槽220。如图13所示，外壳216可包括可沿着纵向轴线L-L行进穿过狭槽220的切割构件222。如图14中的分解图所示，外壳216可包括第一轨道224和第二轨道226。轨道224和轨道226可沿着纵向轴线L-L延伸，使得它们基本上彼此平行。此外，轨道224和轨道226可在基本上垂直于顶部表面218的平面中延伸，其中第二轨道226比第一轨道224更靠近顶部表面218。如图15所示，第一轨道224可开始于定位在外壳216的远侧部分处的起始点225；并且第二轨道226可开始于定位在外壳216的近侧部分处的起始点227。此类布置缩短切割构件222在运动到部署取向之前必须朝远侧行进的距离。
再次参见图13至图18，第一轨道224的远侧部分228可会聚以与第二轨道226相交于接合点230处。轨道224和轨道226可进一步朝远侧延伸超出形成共同轨道部分232的接合点230。切割构件222可包括组织切割刃234、第一销236、第二销238和接合部分240。切割构件222可在近侧起始位置242和远侧结束位置244之间行进，所述近侧起始位置如图15所示可由第一轨道224的起始点225限定，所述远侧结束位置如图17所示位于共同轨道232的远侧端部处。在近侧起始位置242处，第一销236可跨置在第一轨道224中，并且第二销238可跨置在第二轨道226中，致使切割构件222保持在未部署取向中。在未部署取向中，如图15所示，切割构件222的组织切割刃234未被暴露在顶部表面218上方。
如图14中的分解图所示，外科器械200可还包括驱动构件246，所述驱动构件可包括回缩钩248和驱动尖端250。驱动构件246在其近侧部分处能够操作地联接到击发致动器213，使得外科器械200的操作者可通过朝远侧推进击发致动器213来朝远侧推进驱动构件246，并且可通过朝近侧回缩击发致动器213来朝近侧回缩驱动构件246。
参见图15和图16，朝远侧推进驱动构件246可使驱动尖端250与切割构件222的接合部分240配合接合。在第一销236跨置在第一轨道224中并且第二销238跨置在第二轨道226中的情况下，如图16所示，进一步推进驱动构件246可使切割构件222从近侧起始位置242穿过狭槽218朝远侧行进较短距离。
参见图16和图17，可沿着轨道224和轨道226将处于未部署取向的切割构件222朝远侧推进较短距离，直到第一销236进入第一轨道224侧部分228为止。远侧部分228可包括凸轮表面252，当切割构件222被继续朝远侧推进时，所述凸轮表面可致使第一销236朝接合点230提升。结果，切割构件222从如图16所示的未部署取向逐渐转变到如图17所示的部署取向，在未部署取向中，组织切割刃234未被暴露在顶部表面218上方，在部署取向中，组织切割刃234被暴露在顶部表面218上方。换句话讲，推进第一销236抵靠凸轮表面252可致使切割构件222围绕横向于纵向轴线L-L的轴线运动，导致组织切割刃234的部署。
再次参见图16和图17，如上文所述，当切割构件222从未部署取向转变到部署取向时，第一销236可进入共同轨道部分232。此外，如图17所示，切割构件222的接合部分240可脱离与驱动尖端250的配合接合，并且可与回缩钩248形成配合接合。
现在参见图17和图18，部署的切割构件222然后可响应于通过驱动构件246的回缩运动从远侧结束位置244朝近侧行进。如图17所示，组织切割刃234朝近侧呈现在远侧结束位置244处。驱动构件246的回缩可致使切割构件222沿着纵向轴线L-L行进。当切割构件222开始朝近侧行进时，第一销236跨置在共同轨道部分232中，并且第二销238跨置在第二轨道226中。在到达接合点230时，第一销236被阻止通过驱动构件246再次进入第一轨道224的远侧部分228。相反，第一销236进入第二轨道226。如图18所示，销236和销238两者可跨置在第二轨道226中以用于切割构件222的近侧行进的其余部分。
在某些实施例中，第一钳口构件208可包括与第二钳口构件210中的狭槽220对应的狭槽(未示出)。第一钳口构件208的狭槽也可沿着纵向轴线L-L延伸，并且可在切割构件222回缩穿过狭槽220期间接收部署的切割构件222的暴露在顶部表面218上方的区段的顶部部分。
参见图19，大体为300的外科器械可包括柄部302、轴304和端部执行器306。在至少一个实施例中，如图19所示，端部执行器306可包括第一钳口构件308和第二钳口构件310。端部执行器306能够响应于对其施加的击发运动来执行外科活动。第一钳口构件308能够相对于第二钳口构件310在第一位置和第二位置之间运动。第一位置可为打开位置并且第二位置可为闭合位置。在至少一个实施例中，参见图19，第一钳口构件308可枢转地联接到第二钳口构件310。在本公开的范围内设想了用于联接第一钳口构件308和第二钳口构件310的其它合适装置。
再次参见图19，柄部302可包括闭合致动器312、击发致动器313和旋转致动器314。闭合致动器312可枢转地联接到柄部302。闭合致动器312的致动可致使第一钳口构件308相对于第二钳口构件310运动。使旋转致动器314旋转可导致端部执行器106围绕纵向轴线L-L旋转。
参见图20至图24，第二钳口构件310可包括具有顶部表面318的外壳316，所述顶部表面具有沿着纵向轴线L-L穿过其延伸的狭槽320。如图20所示，外壳316可包括可沿着纵向轴线L-L行进穿过狭槽320的切割构件322。如图21所示，所述切割构件322可包括组织切割刃334和位于所述切割构件的远侧部分处的穿刺尖端335。
再次参见图20至图24，外科器械300可还包括驱动构件346，如图21所示，所述驱动构件可包括在其远侧部分处取向的止动构件348。沿远侧方向的驱动构件346在其近侧部分处能够操作地联接到击发致动器313，使得外科器械300的操作者可通过朝远侧推进击发致动器313来朝远侧推进驱动构件346，并且可通过朝近侧回缩击发致动器313来朝近侧回缩驱动构件346。
参见图21至图24，切割构件322可枢转地联接到位于止动构件348近侧的驱动构件346的远侧部分。例如，枢转销350可被用来将切割构件322联接到驱动构件346。在本公开外围内设想了用于将切割构件322联接到驱动构件346的其它装置。如图21至图24所示，切割构件322可相对于驱动构件346围绕穿过枢转销350并且横向于纵向轴线L-L的轴线枢转。使切割构件322围绕枢转销350沿逆时针方向枢转可致使切割构件322从未部署取向转变到部署取向。在未部署取向中，如图21中的实线的实施例所示，切割构件346的组织切割刃334和穿刺尖端335可保持在外壳316的顶部表面318的下方然而在完全部署取向中，如图21中的虚线的实施例所示，切割构件346的组织切割刃334和穿刺尖端335被暴露在外壳316的顶部表面318上方，并且切割构件346抵靠在止动构件348上。
现在参见图22至图24，外壳316可包括部署构件356。如图22所示，通过推进驱动构件346可将处于未部署取向的切割构件322朝远侧推进，直到切割构件322接合部署构件356为止。如图23所示，进一步推进驱动构件346可致使切割构件322围绕枢转销350逆时针旋转，从而转变到部署取向。在本公开的范围内设想了用于部署切割构件322的其它部署布置结构。
外科器械300可被用于执行外科组织横断手术。操作者可致动闭合致动器312以将待切断的组织抓持并固定在第一钳口构件308和第二钳口构件310之间。如上文所述，操作者然后可通过推进击发致动器313来朝远侧推进处于未部署取向的切割构件322。在接合部署构件356时，切割构件322可沿顺时针方向旋转，致使穿刺尖端335穿刺被抓持在钳口构件308和钳口构件310之间的组织。当操作者继续推进驱动构件346时，切割构件322继续旋转，直到切割构件322通过到达止动构件348而被止动为止。操作者然后可通过回缩击发致动器313来回缩完全部署的切割构件322。当切割构件朝近侧回缩时，朝近侧呈现的组织切割刃334可切穿被抓持在钳口构件308和钳口构件310之间的组织。然后通过致动闭合致动器312来打开钳口构件308和钳口构件310以使可从端部执行器306释放切断的组织。
参见图25，大体为400的外科紧固和切割器械可包括柄部402、轴404和端部执行器406。在至少一个实施例中，如图25所示，端部执行器406可包括用于接收钉仓411的钉仓通道410。钉仓411能够操作地在其中支撑外科钉。端部执行器406可还包括砧座408，所示砧座能够枢转地连接到钉仓通道410并且能够通过端部执行器闭合系统在打开位置和闭合位置之间枢转。
为了从钉仓411部署钉，外科器械400可还包括能够横贯钉仓411的钉驱动器和能够在钉仓内推进所示钉驱动器的击发驱动装置。在各种实施例中，当钉从钉仓部署时，砧座408能够使所述钉中的至少一部分变形。端部执行器闭合系统和击发驱动装置的若干实施例公开于2005年6月14日公布的名称为“SURGICAL STAPLING INSTRUMENT INCORPORATING AFIRING MECHANISM HAVING A LINKED RACK TRANSMISSION”的美国专利6,905,057以及2006年5月16日公布的名称为“SURGICALSTAPLING INSTRUMENT HAVING A SINGLE LOCKOUT MECHANISMFOR PREVENTION OF FIRING”的美国专利7,044,352中，这些专利中的每个的公开内容以引用的方式并入本文。
在各种实施例中，根据本发明所述的外科器械可包括用于使端部执行器相对于外科器械的细长轴组件运动或关节运动的系统。例如，外科器械400可包括关节运动接头(未示出)，所述关节运动接头能够运动地连接端部执行器406和轴404。在各种实施例中，关节运动接头可允许端部执行器406相对于轴404在单个平面或另选地在多个平面中运动。在任一种情况下，关节运动接头可包括端部执行器406能够围绕的以进行关节运动的一根或多根枢转轴线。
外科器械400可还包括锁定机构(未示出)，所述锁定机构可固定或锁定端部执行器406和细长轴组件404之间的相关关系。根据本公开的锁定机构公开于在2010年8月31日公布的名称为“SURGICAL INSTRUMENTWITH ARTICULATING SHAFT WITH SINGLE PIVOT CLOSURE ANDDOUBLE PIVOT FRAME GROUND”美国专利7,784,662、在2008年11月25日公布的名称为“SURGICAL INSTRUMENT WITH ARTICULATINGSHAFT WITH RIGID FIRING BAR SUPPORTS”的美国专利7,455,208、以及在2006年7月24日提交的名称为“SURGICAL STAPLING ANDCUTTING DEVICE AND METHOD FOR USING THE DEVICE”的美国专利申请公开2007/0027469A1中，这些专利中的每个的全部公开内容以引用的方式并入本文。
参见图25，柄部402可包括旋转致动器414。旋转致动器414的致动可导致端部执行器406围绕纵向轴线L-L旋转。柄部402可还包括闭合致动器412。闭合致动器412可枢转地联接到柄部402。闭合致动器412的致动可致使砧座408相对于仓通道410运动。根据本公开的柄部和致动机构公开于在1995年11月19日公布的名称为“SURGICAL STAPLER INSTRUMENT”的美国专利5,465,895以及在2010年7月2日提交的名称为“SURGICALSTAPLING INSTRUMENTS”的美国专利申请序列号12/830,013中，这些专利中的每个的全部公开内容以引用的方式并入本文。在例示性实例中，闭合致动器412能够操作地联接到闭合管417。闭合致动器412的致动可致使闭合管417朝远侧运动。闭合管417的远侧运动可影响砧座408朝仓通道410的枢转运动，这可影响组织夹持。
参见图25至图27，外科切割和紧固器械400的柄部402可还包括用于从钉仓411部署钉的击发致动器415。如图26所示，钉仓411可由中央细长狭槽420分开。多个钉接收凹坑419可形成于钉仓411内并被布置成侧向上间隔开的纵向排。如图27所示，钉423能够操作地支撑在相应的驱动器425上，所述相应的驱动器能够运动地定位在凹坑419内。驱动器425可被布置成侧向上间隔开的纵向排。驱动器425能够被滑动地接收在凹坑419内。每个驱动器425可支撑单个钉或多个钉423，使得驱动器425穿过凹坑419的运动可部署单个钉或多个钉423，如图27所示。
仓411可还包括被布置成用于接收楔421的纵向狭槽(未示出)，所述楔提供在击发驱动结构(未示出)的远侧端部处，所述击发驱动结构继而能够操作地联接到柄部402中的击发致动器415。击发致动器415的致动可通过使击发驱动装置通过轴404朝远侧运动来致使楔421朝远侧运动。楔421可朝远侧运动穿过仓411内的纵向狭槽。每个楔421可包括细长部分421a和凸轮部分421b。凸轮部分421b可包括单角度的上部凸轮表面421c。在楔421朝远侧运动时，凸轮表面421c可接合并朝上推动钉仓411中的驱动器425，以实现朝砧座408击发钉423。根据本公开的各种示例性仓设计和激发驱动装置结构公开于在1995年11月19日公布的名称为“SURGICALSTAPLER INSTRUMENT”的美国专利5,465,895以及在2010年3月2日公布的名称为“STAPLE CARTRIDGES FOR FORMING STAPLES HAVINGDIFFERING FORMED STAPLE HEIGHTS”的美国专利7,669,746中，这些专利中的每个的全部公开内容以引用的方式并入本文。
再次参见图25和图26，外科切割和紧固器械400可还包括切割构件致动器413、驱动构件446和切割构件422。切割构件422可沿着纵向轴线L-L行进穿过狭槽420。如图26中的分解图所示，仓411可包括第一轨道424和第二轨道426。轨道424和轨道426可沿着纵向轴线L-L延伸，使得它们基本上彼此平行。此外，轨道424和轨道426可在基本上垂直于顶部表面418的平面中延伸，其中第二轨道426比第一轨道424更靠近顶部表面418。第一轨道424的远侧部分428可会聚以与第二轨道426相交于接合点430处。轨道424和轨道426可进一步朝远侧延伸超出形成共同轨道部分432的接合点430。
参见图26和图28至图31，切割构件422可包括组织切割刃434、第一销436、第二销438和接合部分440。切割构件422可在如图28所示的近侧起始位置442和如图30所示的远侧结束位置444之间行进。在近侧起始位置442处，第一销436可跨置在第一轨道424中，并且第二销438可跨置在第二轨道426中，致使切割构件422保持在未部署取向中。在未部署取向中，如图28所示，切割构件422的组织切割刃434未被暴露在顶部表面418上方。
如图26中的分解图所示，驱动构件446可包括回缩钩448和驱动尖端450。驱动构件446在其近侧部分处能够操作地联接到切割构件致动器413，使得外科器械400的操作者可通过朝远侧推进切割构件致动器413来朝远侧推进驱动构件446，并且可通过朝近侧回缩切割构件致动器413来朝近侧回缩驱动构件446。
参见图28和图29，朝远侧推进驱动构件446可使驱动尖端450与切割构件422的接合部分440配合接合。在第一销436跨置在第一轨道424中并且第二销438跨置在第二轨道426中的情况下，如图29所示，进一步推进驱动构件446可使得切割构件422从近侧起始位置442穿过狭槽420朝远侧行进。
参见图29和图30，可沿着轨道424和轨道426将处于未部署取向的切割构件422朝远侧推进，直到第一销436进入第一轨道424的远侧部分428为止。远侧部分428可包括凸轮表面452，当切割构件422被继续朝远侧推进时，所述凸轮表面可致使第一销436朝接合点430提升。结果，切割构件422从如图29所示的未部署取向逐渐转变到如图30所示的部署取向，在所述未部署取向中，组织切割刃434未被暴露在顶部表面418上方，在所述部署取向中，组织切割刃434被暴露在顶部表面418上方。换句话讲，推进第一销436抵靠凸轮表面452可致使切割构件422围绕横向于纵向轴线L-L的轴线运动，导致切割构件422的部署。
再次参见图29和图30，如上文所述，当切割构件422从未部署取向转变到部署取向时，第一销436进入共同轨道部分432。此外，如图30所示，切割构件422的接合部分440脱离与驱动尖端450的配合接合，并且与回缩钩448形成配合接合。
现在参见图30和图31，部署的切割构件422然后可响应于驱动构件446的回缩运动从远侧结束位置444朝近侧行进到近侧起始位置442。如图30所示，组织切割刃434朝近侧呈现在远侧结束位置444处。驱动构件446的回缩可致使切割构件422沿着纵向轴线L-L朝近侧行进。当切割构件开始朝近侧行进时，第一销436跨置在共同轨道部分432中，并且第二销438跨置在第二轨道426中。在到达接合点430时，第一销436被阻止通过驱动构件446再次进入第一轨道424的远侧部分428。相反，第一销436进入第二轨道426。如图31所示，销436和销438两者可跨置在第二轨道426中以用于切割构件422的近侧行进的其余部分。
在某些实施例中，砧座408可包括与仓411中的狭槽420对应的狭槽(未示出)。砧座408的狭槽也可沿着纵向轴线L-L延伸，并且可在切割构件422回缩穿过狭槽420期间接收部署的切割构件422的暴露在顶部表面418上方的区段的顶部部分。
在某些实施例中，楔421能够操作地被联接以与驱动构件446同时运动，使得共同致动构件(未示出)可同时使楔421和驱动构件446运动。例如，在共同致动构件的第一行程期间，楔421可与驱动构件446同时朝远侧推进，使得当驱动构件446的驱动尖端450与切割构件422的接合部分440配合接合时，楔421与驱动器425接触。在第一行程的其余部分期间，当钉423由楔421部署时，未部署的切割构件422可与楔421同时推进穿过钉仓411。在第一冲程结束时，如前文所讨论并如图30所示，切割构件422可达到完全部署取向，其中组织切割刃434朝近侧呈现在远侧结束位置444处。在共同致动构件的第二冲程期间，切割构件422可回缩以切穿现在用钉423钉住的组织。楔421可与切割构件422同时回缩。
外科器械400可被用于执行外科组织紧固和切割手术。操作者可致动柄部402的闭合构件412，以将组织抓持并固定在砧座408和钉仓411之间。如上文所详述，操作者然后可致动击发致动器415以部署钉423。一旦钉423被击发到组织中，操作者然后可通过推进切割构件致动器413来朝远侧推进处于未部署取向的切割构件422。在到达远侧结束位置444时，切割构件422达到完全部署取向。操作者然后可通过回缩切割构件致动器413来回缩完全部署的切割构件422。当切割构件422朝近侧回缩时，朝近侧呈现的组织切割刃434可切穿被抓持在砧座408和仓411之间的组织。通过致动闭合致动器412来打开砧座408，然后可从端部执行器406释放钉住的切断组织。
参见图32至图36，在另选的实施例中，第一轨道424’可替换钉仓411的第一轨道424。如图33所示，第一轨道424’可沿着钉仓411的长度开始于远侧部分处。切割构件422可从如图33所示的近侧起始位置442’行进到如图35所示的远侧结束位置444。在近侧起始位置442’处，第一销436可跨置在第一轨道424’中，并且第二销438可跨置在第二轨道426中，致使切割构件422保持在未部署取向中。如图33所示，在未部署取向中，切割构件422的组织切割刃434未被暴露在顶部表面418上方。
参见图33和图34，朝远侧推进驱动构件446可使驱动尖端450与切割构件422的接合部分440配合接合。在第一销436跨置在第一轨道424’中并且第二销438跨置在第二轨道426中的情况下，如图34所示，进一步推进驱动构件446可使切割构件422从近侧起始位置242’穿过狭槽420朝远侧行进较短距离。
参见图34和图35，可沿着轨道424’和轨道426将处于未部署取向的切割构件422朝远侧推进较短距离，直到第一销436进入第一轨道424’的远侧部分428’为止。远侧部分428’可包括凸轮表面452’，当切割构件422被继续朝远侧推进时，所述凸轮表面可致使第一销436朝接合点430提升。结果，切割构件422从如图33所示的未部署取向逐渐转变到如图35所示的部署取向，在未部署取向中，组织切割刃434未被暴露在顶部表面418上方，在部署取向中，组织切割刃434被暴露在顶部表面418上方。换句话讲，推进第一销436抵靠凸轮表面452’可致使切割构件422围绕横向于纵向轴线L-L的轴线运动，导致组织切割刃434的部署。
再次参见图35，如上文所述，当切割构件422从未部署取向转变到部署取向时，第一销436进入共同轨道部分432。此外，如图35所示，切割构件422的接合部分440脱离与驱动尖端450的配合接合，并且与回缩钩448形成配合接合。
现在参见图35和图36，部署的切割构件422然后可响应于驱动构件446的回缩运动从远侧结束位置444朝近侧行进。如图35所示，组织切割刃434可朝近侧呈现在远侧结束位置444处。驱动构件446的回缩可致使切割构件422沿着纵向轴线L-L朝近侧行进。当切割构件422开时朝近侧行进时，第一销436跨置在共同轨道部分432中，并且第二销438跨置在第二轨道426中。当到达接合点430时，第一销436被阻止通过驱动构件446再次进入第一轨道424’的远侧部分428’。相反，第一销436进入第二轨道426。如图36所示，销436和销438两者可跨置在第二轨道426中以用于切割构件422的近侧行进的其余部分。
在本说明书中描述和例示了各种实施例，以提供对所公开的装置和方法的元件、步骤和使用的总体理解。应当理解，本说明书中描述和示出的各种实施例是非限制性的和不完全的。因此，本发明不被本说明书中公开的各种非限制性和不完全的实施例的描述限制。在适当情况下，结合各种实施例描述的特征结构和特性可使用其他实施例的步骤、部件、元件、特征结构、方面、特性、局限等等来被组合、修改或识别。此类修改和变型旨在被包括在本说明书的范围内。同样地，权利要求可被修改以引用在本说明书中明确地或固有地描述的或换句话讲由本说明书明确地或固有地支持的任何元件、步骤、限制、特征和/或特性。另外，申请人保留修改权利要求以肯定地放弃存在于现有技术中的元件、步骤、限制、特征结构和/或特性而不顾此类特征是否明确地描述于本文中的权利。因此，任何此类布置遵照35U.S.C.§112第一段和35U.S.C.§132(a)的要求。本说明书中公开的和描述的各种实施例可包括如下、由如下组成或基本上由如下组成：如在本文中各种描述的步骤、限制、特征结构和/或特性。
本文中识别的任何专利、公布、或其他公开材料全部以引用的方式并入本文，除非另外指明，但仅就如下情况而言：所并入的材料不与本说明书中明确地示出的现有定义、声明、或其它公开材料冲突。同样地，就如下必要的情况而言：本说明书中示出的明确的公开内容取代以引用方式并入本文的任何冲突材料。要以引用方式并入本文的但与本文示出的现有定义、声明或其他公开材料冲突的任何材料或其一部分仅在并入的材料和现有的公开材料之间不出现冲突的情况下被并入。申请人保留修改本说明书以明确地叙述以引用方式并入的任何主体或其一部分的权利。
可将本发明所公开的装置设计为单次使用后即进行处理，或者可将它们设计为可多次使用。然而在任一种情况下，该器械均可重新修复，以便在至少一次使用后再次使用。重新修复可包括如下步骤的组合：拆开装置，然后清理或替换特定件，以及随后重新组装。具体地，装置可被拆开，并且装置的任何数目的特定件或部件可以任何组合被选择性地替换或移除。清洗和/或替换特定部件后，该装置可以在重新修复设施处重新组装以随后使用，或者在即将进行外科手术前由外科团队重新组装。本领域普通技术人员将会知道，重新修复装置时可以采用多种不同技术来拆卸、清理/替换和重新组装。此类技术的使用和所得经修复的装置全都在本申请的范围内。
优选地，本文所述的本发明将在手术前得以处理。首先，获得新的或用过的器械，并且如有必要，则进行清理。然后对器械进行消毒。在一种灭菌技术中，将器械置于封闭并密封的容器中，诸如塑料或口袋中。然后将该容器和器械放置在可渗透该容器的辐射场中，诸如亚乙基氧、蒸汽、高压蒸汽灭菌、浸泡在灭菌液体中、伽玛辐射、x射线或更高能量电子。辐射将器械上和容器中的细菌杀死。然后将消毒后的器械储存在无菌容器中。该密封容器将器械保持无菌，直到在医疗设施中打开该容器为止。
Claims (21)
1.一种外科切割器械，包括：
第一钳口构件；
第二钳口构件，所述第二钳口构件能够相对于所述第一钳口构件运动地支撑以在打开位置和闭合位置之间选择性地运动，以在对其施加闭合运动时将组织夹持在所述第一钳口构件和所述第二钳口构件之间；和
切割构件，所述切割构件包括组织切割刃以在对所述切割构件施加回缩运动时切割被夹持在所述第一钳口构件和所述第二钳口构件之间的组织。
2.根据权利要求1所述的外科器械，其中所述切割构件能够从未部署位置运动到部署位置。
3.根据权利要求2所述的外科器械，其中通过使所述切割构件围绕部署轴线运动，所述切割构件能够从所述未部署位置运动到所述部署位置。
4.根据权利要求3所述的外科器械，其中所述第一钳口构件限定纵向轴线，并且其中所述部署轴线横向于所述纵向轴线。
5.根据权利要求3所述的外科器械，其中所述切割构件包括穿刺尖端，所述穿刺尖端能够在所述切割构件围绕所述部署轴线运动时穿刺被夹持在所述第一钳口构件和所述第二钳口构件之间的所述组织。
6.根据权利要求1所述的外科器械，其中所述切割构件包括接合部分，所述接合部分能够与所述外科器械的致动构件可释放地接合。
7.根据权利要求1所述的外科器械，其中所述切割构件能够沿着所述第一钳口构件的长度以收起构型从第一位置朝远侧推进到第二位置。
8.一种与外科缝合器一起使用的外科钉仓组件，所述钉仓组件包括：
钉仓外壳，所述钉仓外壳能够操作地支撑在所述外科缝合器中，其中所述钉仓外壳包括：
顶部表面；
狭槽；和
至少一个钉腔；以及
切割构件，所述切割构件定位在所述钉仓外壳内，所述切割构件包括能够切割组织的组织切割刃，其中所述切割构件能够在对其施加回缩运动时朝近侧回缩穿过所述狭槽，并且其中当所述切割构件朝近侧回缩穿过所述组织时所述组织切割刃朝近侧呈现。
9.根据权利要求8所述的外科钉仓组件，其中所述切割构件能够从未部署位置运动到部署位置。
10.根据权利要求9所述的外科钉仓组件，其中通过使所述切割构件围绕部署轴线运动，所述切割构件能够从所述未部署位置运动到部署位置。
11.根据权利要求9所述的外科钉仓组件，其中所述切割构件包括穿刺尖端，所述穿刺尖端能够在使所述切割构件围绕所述部署轴线运动时穿刺所述组织。
12.根据权利要求8所述的外科钉仓组件，其中所述切割构件包括接合部分，所述接合部分能够与所述外科缝合器的致动构件可释放地接合。
13.根据权利要求8所述的外科钉仓组件，其中所述切割构件被朝远侧推进而不将所述切割构件的所述组织切割刃暴露在所述外科钉仓外壳的所述顶部表面上方。
14.一种外科切割和紧固器械，包括：
细长轴；
细长通道，所述细长通道能够操作地联接到所述细长轴并且能够在其中操作地支撑钉仓；
砧座，所述砧座能够相对于所述细长通道运动地支撑以在打开位置和闭合位置之间选择性地运动，其中响应于从所述细长轴施加到所述砧座的打开运动和闭合运动，组织被夹持在所述砧座和被支撑在所述细长通道内的钉仓之间；和
切割构件，所述切割构件包括组织切割刃，其中所述切割构件能够相对于所述细长通道回缩，并且其中所述组织切割刃能够在所述切割构件的回缩期间切割被夹持在所述砧座和所述钉仓之间的组织。
15.根据权利要求14所述的外科器械，其中所述切割构件能够从未部署位置运动到部署位置。
16.根据权利要求15所述的外科器械，其中通过使所述切割构件围绕部署轴线运动，所述切割构件能够从所述未部署位置运动到部署位置。
17.根据权利要求16所述的外科器械，其中所述切割构件包括穿刺尖端，所述穿刺尖端能够在使所述切割构件围绕所述部署轴线运动时穿刺被夹持在所述砧座和所述钉仓之间的所述组织。
18.根据权利要求14所述的外科器械，其中所述切割构件包括接合部分，所述接合部分能够与所述缝合器的致动构件可释放地接合。
19.根据权利要求14所述的外科器械，其中所述切割构件被朝远侧推进而不将所述切割构件的所述组织切割刃暴露在所述钉仓外壳的所述顶部表面上方。
20.一种外科切割和紧固器械，包括：
第一钳口，所述第一钳口具有外壳，所述外壳包括顶部表面；
第二钳口，所述第二钳口能够在对其施加打开运动和闭合运动时相对于所述第一钳口运动地支撑；
切割构件，所述切割构件包括组织切割刃，所述切割构件能够在对其施加击发运动时从近侧起始位置运动到远侧结束位置，并且在对其施加回缩运动时从所述远侧结束位置运动到所述近侧起始位置，所述切割构件还能够运动地支撑在所述第一钳口的所述外壳内，使得当所述切割构件从所述近侧起始位置运动到远侧结束位置时，所述组织切割刃定位在所述第一钳口的所述外壳的所述顶部表面下方，并且当所述切割构件从所述远侧结束位置运动到所述近侧起始位置时，所述组织切割刃在所述第一钳口的所述外壳的所述顶部表面上方延伸。
21.一种外科钉仓，包括：
包括顶部表面的仓外壳，所述仓外壳能够在其中操作地支撑多个外科钉；
切割构件，所述切割构件能够运动地支撑在所述仓外壳内并包括组织切割刃，所述切割构件能够从近侧起始位置运动到远侧结束位置，并且能够从所述远侧结束位置运动到所述近侧起始位置，所述切割构件还能够运动地支撑在所述仓外壳内，使得当所述切割构件从所述近侧起始位置运动到所述远侧结束位置时，所述组织切割刃定位在所述顶部表面下方，并且当所述切割构件从所述远侧结束位置运动到所述近侧起始位置时，所述组织切割刃在所述顶部表面上方延伸。
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| US13/651,589 | 2012-10-15 | ||
| US13/651,589 US9386985B2 (en) | 2012-10-15 | 2012-10-15 | Surgical cutting instrument |
| PCT/US2013/064195 WO2014062455A1 (en) | 2012-10-15 | 2013-10-10 | Surgical cutting instrument |
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| CN104736069A true CN104736069A (zh) | 2015-06-24 |
| CN104736069B CN104736069B (zh) | 2018-10-12 |
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| CN201380053918.6A Active CN104736069B (zh) | 2012-10-15 | 2013-10-10 | 外科切割器械 |
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| US (1) | US9386985B2 (zh) |
| EP (1) | EP2906128B1 (zh) |
| JP (1) | JP6316826B2 (zh) |
| CN (1) | CN104736069B (zh) |
| BR (1) | BR112015008201B1 (zh) |
| IN (1) | IN2015DN02428A (zh) |
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Also Published As
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|---|---|
| WO2014062455A1 (en) | 2014-04-24 |
| EP2906128A1 (en) | 2015-08-19 |
| PL2906128T3 (pl) | 2018-08-31 |
| IN2015DN02428A (zh) | 2015-09-04 |
| BR112015008201A2 (pt) | 2017-07-04 |
| EP2906128B1 (en) | 2018-04-04 |
| RU2661720C2 (ru) | 2018-07-19 |
| RU2015118158A (ru) | 2016-12-10 |
| US20140103093A1 (en) | 2014-04-17 |
| US9386985B2 (en) | 2016-07-12 |
| CN104736069B (zh) | 2018-10-12 |
| JP2015532150A (ja) | 2015-11-09 |
| JP6316826B2 (ja) | 2018-04-25 |
| BR112015008201B1 (pt) | 2021-07-06 |
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