CN111107796B - 具有定位肋的圆形缝合装置 - Google Patents

具有定位肋的圆形缝合装置 Download PDF

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CN111107796B
CN111107796B CN201780094391.XA CN201780094391A CN111107796B CN 111107796 B CN111107796 B CN 111107796B CN 201780094391 A CN201780094391 A CN 201780094391A CN 111107796 B CN111107796 B CN 111107796B
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anvil
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沈冬明
张细良
S·A·塞德
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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
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Abstract

一种圆形缝合装置(10，100)包含在击发所述缝合装置(10，100)之前将砧座组合件(20，120)定位成与钉仓组合件(18，118)正确对准的结构。所述缝合装置(10，100)包含砧座组合件(20，120)、包含缝合钉仓(18a，125)和外壳壳体(36，126)的钉仓组合件(18，118)以及砧座保持器(30，130)，所述砧座保持器具有包含第一纵向肋(86)的近端部分(84)和包含至少一个第二纵向肋(88)的远端部分。所述第一纵向肋(86)收纳在形成于所述外壳壳体(36，126)内的狭槽(66)内，以防止所述砧座保持器(30，130)相对于所述外壳壳体(36，126)旋转。所述至少一个第二纵向肋(88)收纳在所述砧座组合件(20，120)的纵向通道(70a)内，以防止所述砧座组合件(20，120)相对于所述砧座保持器(30，130)旋转。当前公开的结构消除了对花键(134，136)的需要以及与花键(134，136)的使用相关联的缺点。

Description

具有定位肋的圆形缝合装置
技术领域
本公开涉及圆形缝合装置，并且更具体地说，涉及包含用于将砧座组合件与圆形缝合装置的外壳组合件的缝合钉仓正确地对准的结构的圆形缝合装置。
背景技术
圆形缝合装置被临床医生用于将一个或多个外科手术紧固件，例如缝合钉或两件式紧固件施加到身体组织，以用于将身体组织的区段连接在一起和/或以用于进行吻合。圆形缝合装置总体上包含：钉仓或外壳组合件，其支撑多排环形排列的缝合钉；砧座组合件，其与钉仓组合件可操作地相关联，并且具有缝合钉收纳袋的环形阵列，所述缝合钉收纳袋的环形阵列用于提供所述多排环形排列的缝合钉可以抵靠其形成的表面；以及环形刀片，其用于切割组织。
在典型的组织紧固过程期间，将缝合装置的砧座组合件定位在身体组织的一个区段内，并且将外壳组合件以及缝合装置的支撑外壳组合件的主体部分定位在身体组织的相邻区段中。然后将砧座组合件附接到缝合装置的主体部分，并且致动缝合装置，以使砧座组合件接近钉仓组合件，并且将身体组织区段夹紧在一起。
通常，砧座组合件包含包含花键的砧座轴，所述花键与形成于外壳组合件的外壳壳体内的花键配合，以使砧座组合件的缝合钉形成袋与外壳组合件的缝合钉仓的缝合钉收纳袋对准。花键的未对准经常导致砧座组合件的缝合钉形成袋与外壳组合件的缝合钉收纳袋未对准，使得缝合钉在缝合装置击发期间发生畸形。
仍然需要一种圆形缝合装置，其包含用于将砧座组合件的缝合钉形成袋与外壳组合件的缝合钉收纳袋对准的更可靠的对准结构。
发明内容
在本公开的一方面，外科手术缝合装置包含主体部分和支撑在主体部分的远端部分上的工具组合件。工具组合件包含砧座组合件和钉仓组合件。主体部分包含具有近端部分和远端部分的砧座保持器。砧座保持器的近端部分支撑第一纵向肋，并且砧座保持器的远端部分支撑第二纵向肋。工具组合件的砧座组合件具有砧座轴和支撑在砧座轴的远端部分上的砧座头。砧座轴具有限定孔的多个弹性支腿。弹性支腿向外弯曲，以利于砧座保持器进入到孔中。所述多个弹性支腿中的相邻弹性支腿限定纵向通道。由弹性支腿限定的纵向通道中的至少一个收纳第二纵向肋，以防止砧座轴相对于砧座保持器旋转。外壳组合件支撑在主体部分的远端部分上，并且包含外壳壳体，所述外壳壳体具有限定通孔的内部壳体部分。砧座保持器穿过通孔延伸。衬套支撑在外壳壳体的内部壳体部分的通孔内。衬套限定内部狭槽，所述内部狭槽收纳第一纵向肋，以防止砧座保持器在衬套的通孔内旋转。
在本公开的另一个方面，外科手术缝合装置包含主体部分、砧座组合件和钉仓组合件。主体部分包含砧座保持器，所述砧座保持器具有支撑第一纵向肋的近端部分和支撑至少一个第二纵向肋的远端部分。砧座组合件具有砧座轴和支撑在砧座轴的远端部分上的砧座头。砧座轴限定纵向孔和至少一个纵向通道。纵向孔的尺寸设置成收纳砧座保持器的远端部分。当砧座保持器的远端部分收纳在纵向孔内时，第二纵向肋收纳在至少一个纵向通道内，以防止砧座组合件相对于砧座保持器旋转。外壳组合件支撑在主体部分的远端部分上，并且包含外壳壳体，所述外壳壳体具有限定通孔的内部壳体部分。砧座保持器穿过通孔延伸。限定内部狭槽的衬套支撑在外壳壳体的内部壳体部分的通孔内。内部狭槽收纳砧座保持器的第一纵向肋，以防止砧座保持器在衬套的通孔内旋转。
在实施例中，衬套包含外部狭槽，并且内部壳体部分包含限定通孔的内壁。内部壳体部分的内壁支撑第三纵向肋，所述第三纵向肋收纳在衬套的外部狭槽内，以防止衬套在内部壳体部分的通孔内旋转。
在一些实施例中，砧座保持器的远端部分支撑多个第二纵向肋，其中所述多个第二纵向肋中的每一个收纳在限定在砧座轴的弹性支腿之间的纵向通道中的相应一个纵向通道内。
在某些实施例中，衬套由金属形成。
在实施例中，缝合装置包含手柄组合件以及从手柄组合件向远端延伸的主体部分。
在一些实施例中，外壳组合件可释放地联接到主体部分。
在某些实施例中，衬套的远端部分形成为具有间隔环，所述间隔环定位成接合通孔内的外壳壳体的内部壳体部分的内壁，以将衬套固定在通孔内。
在实施例中，砧座头枢转地支撑在砧座轴上。
附图说明
本文以下参考附图描述了当前公开的外科手术缝合装置的各种实施例，其中：
图1是当前公开的外科手术缝合装置的示例性实施例的侧面透视图，其中工具组合件处于未夹紧位置中；
图2是图1所示的外科手术缝合装置的侧面透视图，其中工具组合件与缝合装置的其余部分分离；
图3是“现有技术”外科手术缝合装置的远端的透视图，其中外科手术缝合装置的工具组合件的砧座组合件与外科手术缝合装置分离；
图4是图1所示的外科手术缝合装置的工具组合件和砧座保持器的侧面透视图，其中工具组合件处于未夹紧位置中，并且外科手术缝合装置的主体以虚线示出；
图5是图4中所示的工具组合件和砧座保持器的分解图；
图6是沿图4的截面线6-6截取的横截面视图；
图7是图5中所示的工具组合件的外壳组合件的近端的侧面透视图，其中移除了轴承构件；
图8是图7中所示的工具组合件的外壳组合件的近端的侧面透视图，其中轴承构件附接到外壳壳体；
图9是沿图8的截面线9-9截取的横截面视图；
图10是图2中所示的外科手术缝合装置的砧座保持器的侧面透视图；
图11是图7中所示的工具组合件的外壳组合件的近端的侧面透视图，其中轴承构件附接到外壳壳体，并且砧座组合件在缩回位置中延伸穿过外壳组合件；
图12是沿图11的截面线12-12截取的横截面视图；
图13是图1中所示的外科手术缝合装置的砧座组合件和砧座保持器的侧面透视图；并且
图14是沿图13的截面线14-14截取的横截面视图。
具体实施方式
现在参考附图对当前公开的外科手术缝合装置进行详细的描述，在附图中，相同的附图标记指代若干视图中的每个视图中的完全相同或对应元件。在此说明书中，术语“近端”一般用于指离临床医生更近的装置的那部分，而术语“远端”一般用于指离临床医生更远的装置的那部分。此外，术语“内窥镜”一般用于指内窥镜、腹腔镜、关节镜和/或通过小直径切口或套管进行的任何其它手术。此外，术语临床医生一般用于指医疗人员，包含医生、护士和辅助人员。
当前公开的圆形缝合装置包含在击发缝合装置之前，将砧座组合件定位成与钉仓组合件对准的结构。缝合装置包含砧座组合件，包含缝合钉仓和外壳壳体的钉仓组合件以及砧座保持器，所述砧座保持器具有包含纵向肋的近端部分和包含至少一个第二纵向肋的远端部分。砧座保持器的第一纵向肋收纳在形成于钉仓组合件的外壳壳体内的狭槽内，以防止砧座保持器相对于外壳壳体旋转。砧座保持器的至少一个第二纵向肋收纳在砧座组合件的纵向通道内，以防止砧座组合件相对于砧座保持器旋转。当前公开的结构消除了对花键的需要以及与花键的使用相关联的缺点。
参考图1和2，总体上示出为10的当前公开的外科手术缝合装置包含手柄组合件12、从手柄组合件12向远端延伸的细长主体部分14、以及支撑在细长主体部分14的远端部分上的工具组合件16。工具组合件16包含砧座组合件20以及支撑缝合钉仓18a的钉仓或外壳组合件18。手柄组合件12包含：接近旋钮22，所述接近旋钮操作接近机构(未示出)以使砧座组合件20相对于钉仓组合件18在未夹紧位置与夹紧位置之间移动；和击发触发器24，所述击发触发器操作击发机构(未示出)以将缝合钉(未示出)从缝合钉仓18a击发到组织中。关于包含已知的接近机构和击发机构的示例性圆形缝合装置的详细描述，参见美国专利第7,857,187号(“'187专利”)，所述专利以全文引用的方式并入本文中。
尽管当前公开的缝合装置10示出并描述为手动驱动装置，但是设想了缝合装置10可以是电力驱动装置，如美国专利公开第2012/0253329号中所描述的，所述专利以全文引用的方式并入本文中。
外壳组合件18的缝合钉仓18a具有环形配置，并且砧座组合件20包含具有环形配置的砧座20a(图5)。砧座组合件20支撑在砧座保持器30上，所述砧座保持器形成缝合装置10的接近机构(未示出)的一部分，并且被配置成可释放地接合砧座组合件20。砧座保持器30包含从缝合装置10的细长主体部分14的远端延伸并穿过外壳组合件18到达接合砧座组合件20的位置的远端部分以及可操作地连接到接近旋钮22的近端部分，使得接近旋钮22的旋转使砧座组合件20相对于外壳组合件18的缝合钉仓18a在未夹紧或间隔位置与夹紧位置之间移动。外壳组合件18包含环形刀28(图1)，在击发缝合装置10期间，所述环形刀可在外壳组合件18内从缩回位置移动到前进位置，以横切夹紧在缝合钉仓18a与砧座20a之间的组织。
外壳组合件18可释放地联接到缝合装置10的细长主体14的远端部分，以便于在每次使用之后更换外壳组合件18。用于将外壳组合件18可释放地联接到缝合装置10的细长主体部分14的机构描述于美国专利公开第2016/0310141号、第2016/0192938号和第2016/0192934号中，所述专利以全文引用的方式并入本文中。
参考图3，在“现有技术”圆形缝合装置100中，砧座组合件120包含砧座头122和砧座轴124，并且外壳组合件118包含缝合钉仓125和外壳壳体126，所述外壳壳体具有限定通孔128a的内部壳体部分128。砧座保持器130收纳在通孔128a内，并且可在缩回位置与前进位置之间移动。当砧座轴124联接到砧座保持器130，并且砧座保持器130缩回时(通过图1的接近旋钮22的致动)，砧座轴124被拉入到外壳壳体126的内部壳体部分128的通孔128a中。为了将砧座组合件120的砧座头122与外壳组合件118的缝合钉仓125正确对准，砧座轴124包含花键134，所述花键收纳在沿外壳壳体126的内部壳体部分128的内壁形成的花键136之间。砧座轴124的花键134在外壳壳体126的花键136之间的接收导致砧座组合件120的砧座头122相对于壳体组合件118的缝合钉仓125旋转，以在砧座组合件120和外壳组合件118接近期间，使缝合钉仓125与砧座头124正确对准。如以上简要讨论的，花键134和136偶尔彼此碰撞或约束，并且砧座组合件120与外壳组合件118之间无法正确对准。此类碰撞和/或约束可能导致缝合钉形成不当或锁定缝合装置100。
参考图4-6，如上所述，当前公开的缝合装置10(图1)的工具组合件16包含外壳组合件18和砧座组合件20。外壳组合件18包含支撑缝合钉仓18a的外壳壳体36和推动器38(图6)。外壳壳体36包含内部壳体部分40(图6)，所述内部壳体部分限定通孔42。砧座组合件20包含砧座轴44和支撑在砧座轴44的远端部分上的砧座头46。在实施例中，砧座头46被枢转地支撑在砧座轴44上，并且被偏置机构48推动到倾斜位置。枢转砧座头46和偏置机构48在本领域中是已知的，并且不构成本申请中公开的改进的一部分。美国专利第9,492,168号和第8,540,132号公开了示例性的枢转砧座组合件和偏置机构，并且以全文引用的方式并入本文中。
在实施例中，外壳壳体36的内部壳体部分40的通孔42(图6)包含近端部分50，所述近端部分具有增大的直径，从而在通孔42的远端部分与近端部分50之间限定梯级52。外壳组合件18包含基本圆柱形的衬套60，所述衬套收纳在通孔42的近端部分50中。衬套60限定与外壳壳体36的内部壳体部分40的通孔42同轴的通孔62。在实施例中，衬套60限定了外部狭槽64和内部狭槽66，这将在下面进一步详细描述。在一些实施例中，衬套60的远端部分形成有间隔环68，所述间隔环的尺寸设置成接合外壳壳体36的内部壳体部分40的内壁，以将衬套60固定在通孔42的近端部分50内。或者，可以使用其它联接方法或装置，将衬套60固定在外壳壳体36的内部壳体部分40内。在一些实施例中，衬套60由如例如不锈钢等金属刚性高强度材料形成。美国专利第9,492,168号(“'168专利”)以全文引用的方式并入本文中。
砧座组合件20包含砧座轴44和支撑在砧座轴44的远端部分上的砧座头46。在实施例中，砧座轴44包含近端部分，所述近端部分具有限定孔72的多个弹性支腿70。弹性支腿70彼此间隔开，以在相邻的弹性支腿70之间限定纵向通道70a。孔72的尺寸设置成容纳砧座保持器30，以将砧座轴44可释放地固定到砧座保持器30。弹性支腿70中的每一个的内壁74限定了凹口76，所述凹口限定了肩部76a。凹口76收纳形成于砧座保持器30的外表面上的支座78，如本领域中已知的，以将砧座保持器30的远端部分固定在砧座轴44的孔72内。参见例如'168专利。
砧座保持器30被固定到接近机构(未示出)的远端部分，并且通过旋转接近旋钮22(图1)，在外壳壳体36的内部壳体部分40的通孔42内前进或缩回。在实施例中，砧座保持器30包含远端部分80和较大直径的近端部分84，所述远端部分限定了具有锥形远端的套管针82，所述近端部分收纳在外壳壳体36的内部壳体部分40的通孔42内，并且固定到外科手术缝合装置的接近机构(未示出)。在实施例中，砧座保持器30的近端部分84(图5)支撑纵向延伸的第一肋86，并且砧座保持器30的远端部分80包含至少一个第二肋88。在实施例中，至少一个第二肋88包含两个肋88。
当砧座组合件20联接到砧座保持器30时，砧座保持器30的远端部分插入到限定在弹性支腿70的近端处的开口90(图5)中。当形成于砧座保持器30的外表面上的支座78接合弹性支腿70时，弹性支腿70向外弯曲，以促进砧座保持器30进一步进入到砧座轴44中。当支座78移动到与凹口76对准时(图6)，弹性支腿70向内弯曲，使得支座78收纳在凹口76内，并且砧座组合件20可释放地固定到砧座保持器30。支座78限定肩部78a，所述肩部接合限定凹口76的肩部76a，以抵抗砧座组合件20与砧座保持器30的分离。
还参考图7-9，外壳壳体36的内部壳体部分40包含内壁92，所述内壁限定了内部壳体部分40的通孔42。内壁92支撑纵向肋94。当将衬套60固定在外壳壳体36的内部壳体部分40的通孔42(图9)内时，纵向肋94收纳在限定在衬套60的远端部分中的外部狭槽64内(图9)。将纵向肋94放置在衬套60的外部狭槽64内将防止衬套60在外壳壳体36的内部壳体部分40内旋转。
参考图10-12，如上所述，衬套60的通孔62限定了内部狭槽66(图12)。当砧座保持器30收纳在衬套60的通孔62内时，形成于砧座保持器30的近端部分84上的纵向延伸的第一肋86收纳在衬套60的内部狭槽66内。将纵向延伸的第一肋86放置在衬套60的内部狭槽66内将防止砧座保持器30在衬套60内旋转。
参考图13和14，当砧座保持器30滑入到砧座轴44的孔72中时(图5)，形成于砧座保持器30的远端部分80上的纵向延伸的第二肋88收纳在相应的纵向通道70a中，所述纵向通道限定在砧座轴44的弹性支腿70之间。将纵向延伸的第二肋88收纳在限定于弹性支腿70之间的通道70a内将防止砧座组合件20相对于砧座保持器30旋转。
在当前公开的缝合装置10中，砧座组合件20的砧座轴44不包含花键。通过在砧座保持器30上包含第一纵向肋86和第二纵向肋88，将防止砧座组合件20的砧座头46与外壳组合件18的缝合钉仓18a之间的相对旋转，从而防止砧座保持器30相对于外壳壳体36旋转，并且防止砧座组合件20相对于砧座保持器30旋转。
本领域技术人员将理解，本文具体描述并在附图中展示的装置和方法是非限制性示例性实施例。可以设想，在不脱离本公开的范围的情况下，结合一个示例性实施例展示或描述的元件和特征可以与另一个的元件和特征组合。而且，基于上述实施例，本领域技术人员将理解本公开的另外的特征和优点。因此，除了由所附权利要求指示之外，本公开不受已经具体示出和描述的内容的限制。

Claims (16)

1.一种外科手术缝合装置，其包括：
主体部分，所述主体部分包含砧座保持器，所述砧座保持器具有近端部分和远端部分，所述近端部分支撑第一纵向肋，并且所述远端部分支撑第二纵向肋；
砧座组合件，所述砧座组合件具有砧座轴和支撑在所述砧座轴的远端部分上的砧座头，所述砧座轴具有限定孔的多个弹性支腿，所述弹性支腿向外呈柔性，以利于所述砧座保持器通到所述孔中，所述多个弹性支腿中的相邻弹性支腿限定纵向通道，由所述弹性支腿限定的所述纵向通道中的至少一个收纳所述第二纵向肋，以防止所述砧座轴相对于所述砧座保持器旋转；
外壳组合件，所述外壳组合件支撑在所述主体部分的远端部分上，所述外壳组合件包含外壳壳体，所述外壳壳体具有限定通孔的内部壳体部分，所述砧座保持器延伸穿过所述通孔；以及
衬套，所述衬套支撑在所述外壳壳体的所述内部壳体部分的所述通孔内，所述衬套限定内部狭槽，其中所述内部狭槽收纳所述第一纵向肋，以防止所述砧座保持器在所述衬套的所述通孔内旋转。
2.根据权利要求1所述的外科手术缝合装置，其中所述衬套包含外部狭槽，并且所述内部壳体部分包含限定所述通孔的内壁，所述内部壳体部分的所述内壁支撑第三纵向肋，所述第三纵向肋收纳在所述衬套的所述外部狭槽内，以防止所述衬套在所述内部壳体部分的所述通孔内旋转。
3.根据权利要求1所述的外科手术缝合装置，其中所述砧座保持器的所述远端部分支撑多个第二纵向肋，其中所述多个第二纵向肋中的每一个收纳在限定在所述砧座轴的所述弹性支腿之间的所述纵向通道中的相应一个纵向通道内。
4.根据权利要求1所述的外科手术缝合装置，其中所述衬套由金属形成。
5.根据权利要求1所述的外科手术缝合装置，其进一步包含手柄组合件，所述主体部分从所述手柄组合件向远端延伸。
6.根据权利要求1所述的外科手术缝合装置，其中所述外壳组合件可释放地联接到所述主体部分。
7.根据权利要求2所述的外科手术缝合装置，其中所述衬套的远端部分形成为具有间隔环，所述间隔环定位成在所述通孔内接合所述外壳壳体的所述内部壳体部分的所述内壁，以将所述衬套固定在所述通孔内。
8.根据权利要求1所述的外科手术缝合装置，其中所述砧座头可枢转地支撑在所述砧座轴上。
9.一种外科手术缝合装置，其包括：
主体部分，所述主体部分包含砧座保持器，所述砧座保持器具有支撑第一纵向肋的近端部分和支撑至少一个第二纵向肋的远端部分；
砧座组合件，所述砧座组合件具有砧座轴和支撑在所述砧座轴的远端部分上的砧座头，所述砧座轴限定纵向孔和至少一个纵向通道，所述纵向孔的尺寸设置成收纳所述砧座保持器的所述远端部分，其中当所述砧座保持器的所述远端部分收纳在所述纵向孔内时，所述第二纵向肋收纳在所述至少一个纵向通道内，以防止所述砧座组合件相对于所述砧座保持器旋转；
外壳组合件，所述外壳组合件支撑在所述主体部分的远端部分上，所述外壳组合件包含外壳壳体，所述外壳壳体具有限定通孔的内部壳体部分，其中所述砧座保持器延伸穿过所述通孔；以及
衬套，所述衬套支撑在所述外壳壳体的所述内部壳体部分的所述通孔内，所述衬套限定内部狭槽，其中所述内部狭槽收纳所述砧座保持器的所述第一纵向肋，以防止所述砧座保持器在所述衬套的所述通孔内旋转。
10.根据权利要求9所述的外科手术缝合装置，其中所述衬套包含外部狭槽，并且所述内部壳体部分包含限定所述通孔的内壁，所述内部壳体部分的所述内壁支撑第三纵向肋，所述第三纵向肋收纳在所述衬套的所述外部狭槽内，以防止所述衬套在所述内部壳体部分的所述通孔内旋转。
11.根据权利要求9所述的外科手术缝合装置，其中所述砧座保持器的所述远端部分支撑多个第二纵向肋，所述多个第二纵向肋中的每一个收纳在限定在所述砧座轴之间的所述至少一个纵向通道中的相应一个纵向通道内。
12.根据权利要求9所述的外科手术缝合装置，其中所述衬套由金属形成。
13.根据权利要求9所述的外科手术缝合装置，其进一步包含手柄组合件，所述主体部分从所述手柄组合件向远端延伸。
14.根据权利要求9所述的外科手术缝合装置，其中所述外壳组合件可释放地联接到所述主体部分。
15.根据权利要求10所述的外科手术缝合装置，其中所述衬套的远端部分形成为具有间隔环，所述间隔环定位成在所述通孔内接合所述内部壳体部分的所述内壁，以将所述衬套固定在所述通孔内。
16.根据权利要求9所述的外科手术缝合装置，其中所述砧座头可枢转地支撑在所述砧座轴上。
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