CN103156659B - 包括通过凸起联接的支撑件的手术吻合装置 - Google Patents
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Abstract
本发明公开一种包括通过凸起联接的支撑件的手术吻合装置。用于通过环形阵列的手术吻合钉来结合两个中空器官段的装置包括：吻合钉钉仓部件、砧座部件、支撑部件和紧固元件。吻合钉钉仓部件包括布置成环形阵列的多个手术吻合钉。砧座部件能够相对于吻合钉钉仓部件在间隔位置和接近位置之间移动，以可调节地夹紧吻合钉钉仓部件和砧座部件之间的器官段。支撑部件被配置且定尺寸为定位在吻合钉钉仓部件的远侧表面和砧座部件的近侧表面上。尤其是，支撑部件包括支撑元件和从支撑元件向近侧延伸的多个周向布置的凸起。紧固元件被配置且定尺寸为接合多个周向布置的凸起以将支撑部件稳固地定位于吻合钉钉仓部件上。
Description
技术领域
本公开涉及用于将手术紧固件或吻合钉施加至体组织的手术器械，尤其涉及用于端-端吻合术型吻合装置的手术支撑件。
背景技术
吻合术是用手术结合分开的中空器官段。典型地，吻合术操作是这样的外科手术：移除中空组织的病变或缺陷段并且结合剩下的端段。取决于期望的吻合术操作，可以通过圆形、端-端或侧-侧器官重构方法来结合端段。
在圆形吻合术操作中，依靠吻合器械来结合器官段的两个端部，吻合器械驱动圆形阵列的吻合钉穿过每个器官段的端段，同时去掉被驱动的圆形阵列的吻合钉内侧的任何组织的中心部分以释放管状通道。典型地，这些器械包括细长轴，细长轴在近侧端具有手柄部以致动该器械，在远侧端设置有吻合钉保持部件。砧座组件安装在邻近吻合钉保持部件的远侧端，砧座组件包括砧座轴，砧座轴联接有砧座头。待吻合器官的相对两端段被夹紧在砧座头和吻合钉保持部件之间。通过从吻合钉保持部件驱动多个吻合钉使得吻合钉的端部穿过组织并且被砧座头变形，来使所夹紧的组织吻合。
在使用中，器官的一个端段固定至砧座组件周围，而器官的另一个端段邻近吻合钉保持部件被保持在适当位置。砧座组件的轴可移除地连接至该器械。一旦砧座轴固定至该器械，就拉动砧座使其紧密接近吻合钉保持部件。然后该器械发射以使得吻合钉穿过器官的两个段的组织并且抵靠砧座而变形。在发射步骤期间，圆形刀具被推动以切割吻合钉钉线内的组织，从而建立器官的两个段之间的通道。在发射之后，典型地，通过将砧座缩回穿过吻合钉钉线而移除该器械，在这之后，医生将仔细检查手术部位以确保已经实现适当的吻合术。
尽管圆形吻合器在许多手术操作中是有用的，但是也会产生一些问题，诸如吻合口瘘、吻合器抽取期间的组织撕裂、出血以及可能发生其他并发症。为了弥补这种问题，已经利用了支撑件或加固材料。但是，由于定位和固定这种材料于器械的固有困难，对能够安全有效地定位在吻合钉钉仓和/或砧座内的支撑件材料以及支撑件材料与器械结合存在持续的需求。
发明内容
根据本公开的实施例，提供了一种用于通过环形阵列的手术吻合钉来结合两个中空器官段的装置。所述装置包括：吻合钉钉仓部件、砧座部件、支撑部件以及紧固部件。所述吻合钉钉仓部件包括布置成环形阵列的多个手术吻合钉。所述砧座部件能够相对于所述吻合钉钉仓部件在间隔位置和接近位置之间移动，以可调节地夹紧所述吻合钉钉仓部件和所述砧座部件之间的器官段。所述支撑部件被配置且定尺寸为定位在所述吻合钉钉仓部件的远侧表面上。所述支撑部件包括支撑元件和从所述支撑元件向近侧延伸的多个周向布置的凸起。所述紧固元件被配置且定尺寸为接合所述多个周向布置的凸起，以将所述支撑部件稳固地定位于所述吻合钉钉仓部件上。
在实施例中，所述支撑元件可以具有环形配置。尤其是，所述支撑元件可以同心地设置成与所述多个手术吻合钉成并置关系。所述紧固元件可以是环形圈，所述环形圈被配置且定尺寸为施加向内的力至抵靠所述吻合钉钉仓部件的外壁的所述多个周向布置的凸起。另外，所述紧固元件可以是缝合线，所述缝合线系在抵靠所述吻合钉钉仓部件的外壁的所述多个周向布置的凸起周围。
在另一实施例中，所述吻合钉钉仓部件的所述外壁可以限定配置为且适于容纳所述多个周向布置的凸起的一部分的周向凹槽。所述紧固元件可以与所述周向凹槽配准（registration）。
所述装置还可以包括同心地布置在所述吻合钉钉仓部件中以及与所述支撑元件同心地布置的刀具元件。所述刀具元件可以相对于所述吻合钉钉仓部件移动。尤其是，所述支撑元件可以被配置为设置在所述刀具元件的径向外侧。
所述多个周向布置的凸起的每一个均可以限定邻近所述支撑元件的削弱线，以允许所述支撑元件与多个所述凸起分离。所述支撑部件可以配置为使得所述多个周向布置的凸起接合所述吻合钉钉仓部件的内壁。
根据本公开的另一实施例，提供了一种用于通过环形阵列的手术吻合钉来结合两个中空器官段的装置。所述装置包括：吻合钉钉仓部件、砧座部件、支撑部件以及紧固部件。所述吻合钉钉仓部件包括成环形阵列的多个手术吻合钉。所述砧座部件能够相对于所述吻合钉钉仓部件在间隔位置和接近位置之间移动，以可调节地夹紧所述吻合钉钉仓部件和所述砧座部件之间的器官段。所述支撑部件被配置且定尺寸为定位在所述吻合钉钉仓部件的远侧表面上。尤其是，所述支撑部件包括支撑元件和从所述支撑元件向近侧延伸的外边缘。所述外边缘被配置为且适于接合所述吻合钉钉仓部件的外壁。所述紧固元件系在所述支撑部件的所述外边缘周围，以将所述外边缘抵靠在所述吻合钉钉仓部件的所述外壁而固定。
在实施例中，所述外边缘可以包括多个周向布置的环圈，所述环圈被配置为且适于容纳穿过其中的所述紧固元件。可选择地，所述外边缘可以限定多个周向布置的开口，所述开口被定尺寸为容纳穿过其中的所述紧固元件。此外，每个开口可以包括粘着剂以将所述紧固元件固定于所述开口中。所述外边缘可以限定邻近所述支撑元件的周向削弱线，以使得所述支撑元件能够与所述外边缘分离。
根据本公开的又一实施例，提供了一种用于通过环形阵列的手术吻合钉来结合两个中空器官段的装置。所述装置包括：吻合钉钉仓部件、砧座部件、刀具元件和支撑部件。所述吻合钉钉仓部件包括成环形阵列的多个手术吻合钉。所述砧座部件限定用于成形所述手术吻合钉的多个吻合钉穴。所述砧座部件能够相对于所述吻合钉钉仓部件在间隔位置和接近位置之间移动，以可调节地夹紧所述吻合钉钉仓部件和所述砧座部件之间的器官段。所述刀具元件同心地设置在所述吻合钉钉仓部件中。所述刀具元件能够相对于所述吻合钉钉仓部件移动。所述支撑部件包括同心地对准所述多个手术吻合钉的支撑元件以及从所述支撑元件向近侧延伸的多个周向布置的凸起。多个所述凸起和所述吻合钉钉仓部件具有对应的联接元件，以将多个所述凸起固定至所述吻合钉钉仓部件。
在实施例中，所述联接元件可以是钩和环紧固件。尤其是，所述吻合钉钉仓部件在其外壁上可以具有钩和环紧固件，并且多个所述凸起可以在其内表面上具有对应的所述钩和环紧固件。可选择地，所述吻合钉钉仓部件可以在其内壁上具有钩和环紧固件，并且多个所述凸起可以在其外表面上具有对应的所述钩和环紧固件。
根据本公开的再一实施例，提供了一种用于通过环形阵列的手术吻合钉来结合两个中空器官段的装置。所述装置包括：吻合钉钉仓部件、砧座部件、刀具元件以及第一支撑部件。所述吻合钉钉仓部件包括成环形阵列的多个手术吻合钉。所述砧座部件包括砧座元件和从所述砧座元件向远侧延伸的轴，所述砧座元件限定用于成形所述手术吻合钉的多个吻合钉穴。所述砧座部件能够相对于所述吻合钉钉仓部件在间隔位置和接近位置之间移动，以可调节地夹紧所述吻合钉钉仓部件和所述砧座部件之间的器官段。所述刀具元件同心地设置在所述吻合钉钉仓部件中。所述刀具元件能够相对于所述吻合钉钉仓部件移动。所述第一支撑部件包括同心地对准所述砧座部件的支撑元件和从所述支撑元件向远侧延伸的边缘。所述第一支撑部件包围限定在所述砧座元件中的所述多个吻合钉穴。
所述装置还可以包括紧固元件，其将所述第一支撑部件固定至所述砧座部件的所述轴。尤其是，所述紧固元件可以包括多个倒刺。所述第一支撑部件的所述边缘可以是接合所述砧座元件的外表面的外边缘。另外，所述第一支撑部件还可以包括从所述支撑元件向远侧延伸的内边缘。所述内边缘可以被配置且定尺寸为接合所述砧座部件的所述轴。
在实施例中，所述装置还可以包括同心地对准所述吻合钉钉仓部件的第二支撑部件。所述第二支撑部件可以包括支撑元件和从所述支撑元件向近侧延伸的多个周向布置的凸起。多个所述凸起可以接合所述吻合钉钉仓部件的外壁。尤其是，多个所述凸起和所述吻合钉钉仓部件的所述外壁可以包括对应的钩和环紧固件，以将所述第二支撑部件固定至所述吻合钉钉仓部件。
每个凸起可以包括邻近所述支撑元件的削弱线，用于所述支撑元件与多个所述凸起分离。所述支撑部件可以配置为使得多个所述凸起接合所述吻合钉钉仓部件的内壁。多个所述凸起和所述吻合钉钉仓部件的所述内壁可以包括对应的钩和环紧固件，以将所述第二支撑部件固定至所述吻合钉钉仓部件。
所述装置还可以包括紧固元件，其被配置且定尺寸为接合所述多个周向布置的凸起，以将所述第二支撑部件稳固地定位于所述吻合钉钉仓部件上。所述紧固元件可以是环形圈，所述环形圈被配置且定尺寸为施加向内的力至抵靠所述吻合钉钉仓部件的外壁的所述多个周向布置的凸起。可选择地，所述紧固元件可以是缝合线，所述缝合线系在抵靠所述吻合钉钉仓部件的外壁的所述多个周向布置的凸起周围。
附图说明
以下参考附图描述本公开的各种实施例，其中：
图1是环形手术吻合装置的立体图，该装置配置为与根据本公开实施例的手术支撑组件一起使用；
图2是图1的手术吻合装置的头部的立体图，示出了安装在吻合钉钉仓组件的远侧部上的手术支撑组件；
图3是图2的头部的零件拆开的分解立体图；
图4是图2所指示细节的区域的放大截面图；
图5是手术吻合装置的头部的立体图，头部包括根据本公开的另一实施例的手术支撑组件；
图6是图5的头部的零件拆开的分解立体图；
图7是图5所指示细节的区域的放大截面图；
图8是图1的环形手术装置的立体图，示出了装置插入两个中空器官段；
图9是图8的装置的头部的局部放大纵向截面图；
图10是图8的装置的头部的局部放大纵向截面图，示出了两个中空器官段的吻合和切割；
图11是手术吻合装置的头部的立体图，头部包括根据本公开的又一实施例的手术支撑组件；
图12是图11的头部的零件拆开的分解立体图；
图13是图11所指示细节的区域的放大截面图；
图14是手术吻合装置的头部的立体图，头部包括根据本公开的又一实施例的手术支撑组件；
图15是图14的头部的零件拆开的分解立体图；
图16是图14所指示细节的区域的放大截面图；
图17是手术吻合装置的头部的立体图，头部包括根据本公开的再一实施例的手术支撑组件；
图18是图17的头部的零件拆开的分解立体图；
图19是图17所指示细节的区域的放大截面图；
图20是手术吻合装置的头部的立体图，头部包括根据本公开的再一实施例的手术支撑组件；
图21是图20的头部的零件拆开的分解立体图；
图22是图20所指示细节的区域的放大截面图；
图23是手术吻合装置的头部的立体图，头部包括根据本公开的又一实施例的手术支撑组件，示出了砧座组件和与手术吻合装置分离的手术支撑组件；
图24是砧座组件和稳固地定位在砧座组件上的图23的手术支撑组件的立体图；
图25是手术吻合装置的头组件的零件拆开的分解立体图，头组件包括根据本公开的再一实施例的手术支撑组件；以及
图26是砧座组件和稳固地定位在砧座组件上的图25的手术支撑组件的立体图；
具体实施方式
现在将参考附图详细描述本公开的实施例，在若干视图的每个中，相似附图标记指示相同或对应的元件。如此处使用的，术语“远侧”如常规一样将指代器械、装置、设备或其部件的远离用户的那部分，而术语“近侧”将指代器械、装置、设备或其部件的靠近用户的那部分。在以下说明中，不再详细描述公知功能或配置以避免用不必要的细节使本公开不清晰。
参考图1，示出了用于执行中空器官的圆形吻合术的手术吻合装置10。手术吻合装置10驱动圆形阵列的吻合钉7（图9）穿过每个器官的端段，并且同时发射柱形刀具76（图9）以去掉被驱动的圆形阵列的吻合钉7径向内侧的任何组织的中心部分以释放管状通道，从而结合器官的两个端部。手术吻合装置10包括：手柄组件20，其具有一对枢转致动手柄元件22和推动器件24，推动器件24包括旋转抓握元件26；从手柄组件20向远侧延伸的细长主体部30；以及头部50，头部50包括砧座组件60、吻合钉钉仓组件70以及根据本公开实施例的手术支撑组件100。
手术装置10的各部件通常由热塑性塑料（包括聚碳酸酯）以及金属（包括不锈钢和铝）形成。所选择的用以形成特定部件的特定材料将取决于特定部件的强度要求。吻合钉7是传统类型的，其包括钉冠（backspan），钉冠具有从钉冠延伸出的一对钉腿。钉腿的终端是组织刺穿尖端。
手柄组件20能够被致动以使砧座组件60相对于吻合钉钉仓组件70接近，并且施加一对环形阵列的吻合钉7穿过组织。为了适当地定位组织于头部50中，旋转抓握元件26可以被旋转以相对于吻合钉钉仓组件70在间隔位置和接近位置之间轴向移动砧座组件60，在所述接近位置，砧座组件60定位为邻近吻合钉钉仓组件70以夹紧它们之间的组织。手柄元件22可以被捏握以发射吻合钉7穿过组织，从而将管状组织的两个段“T1”、“T2”（图9）结合于一起，以下将详细讨论。
细长主体部30被构造为沿其长度具有稍微弯曲/弯折的形状。但是，细长主体部30还可以是直的，以及是柔性的从而可弯折成任何构造。细长主体部30的长度、形状和/或直径可以变化以适于特定手术操作。
参考图2至图4，头部50包括砧座组件60、吻合钉钉仓组件70以及可拆卸地与吻合钉钉仓组件70固定在一起的手术支撑组件100。吻合钉钉仓组件70可以固定地连接至细长主体部30的远侧端部，或者可以被配置为同心地装配在细长主体部30的远侧端部内。尤其是，吻合钉钉仓组件70限定一对环形阵列的吻合钉容纳狭槽72，吻合钉7设置在每一个吻合钉容纳狭槽72中，并且吻合钉钉仓组件70在其外壁79中限定周向布置的凹槽71（图4），诸如埋头槽。
另外，吻合钉钉仓组件70包括与一对环形阵列的吻合钉7以及多个吻合钉推进器9（图9）同心地布置的柱形刀具76，每个吻合钉推进器9设置在相应吻合钉容纳狭槽72中以将相应吻合钉7射出狭槽72。在使用中，吻合钉7朝向砧座组件60行进穿过狭槽72和组织以用于其成形。
简要地参考图9，柱形刀具76包括限定了适于切割组织的刀刃的远侧边缘79。当致动手柄元件22时，柱形刀具76向远侧移动以切割组织，并且多个推进器9向远侧移动以朝向砧座组件60射出设置于吻合钉容纳狭槽72中的吻合钉7。
尤其返回参考图3，定位在吻合钉钉仓组件70的远侧的是砧座组件60，砧座组件60包括砧座元件62和从砧座元件62向近侧延伸的轴64。砧座元件62包括用于容纳和成形吻合钉7的多个穴（未示出）。轴64被配置为可拆卸地容纳在设置于细长主体部30中的接近轴75中。接近轴75可操作地联接手柄组件20的旋转抓握元件26，由此旋转抓握元件26的旋转会使接近轴75轴向移动。接近轴75的这种轴向移动会传递至可拆卸地联接接近轴75的砧座组件60。通过这种方式，砧座组件60能够相对于吻合钉钉仓组件70在间隔位置和砧座组件60定位为邻近吻合钉钉仓组件70的接近位置之间轴向移动，以可调节地夹紧砧座组件60和吻合钉钉仓组件70之间的组织。
用于执行中空器官的圆形吻合术的器械的示例在以下美国专利中描述：第6,053,390号、第5,588,579号、第5,119,983号、第5,005,749号、第4,646,745号、第4,576,167号和第4,473,077号，所述每个专利都被通过引用而全文并入此处。
继续参考图3和图4，手术支撑组件100包括支撑部件110和紧固元件，紧固元件呈环形圈130的形式，其被配置且定尺寸为将支撑部件110固定于吻合钉钉仓组件70上。设置支撑部件110以加固和密封由手术吻合装置10施加到组织上的吻合钉钉线。
支撑部件110包括：支撑元件112，其具有环形轮廓，配置为同心地对准吻合钉钉仓组件70；以及从支撑元件112向近侧延伸的多个周向布置的凸起（tab）120。在使用中，支撑元件112安装在吻合钉钉仓组件70的远侧表面74上。支撑元件112的环形轮廓被配置且定尺寸为当安装在吻合钉钉仓组件70上时与吻合钉钉仓组件70的外周缘齐平。而且，支撑元件112与一对环形阵列吻合钉容纳狭槽72叠置。通过这种方式，当吻合钉7被射出穿过一对环形阵列吻合钉容纳狭槽72时，每个吻合钉7的钉腿刺穿支撑元件112，并且吻合钉7的钉冠固定至或抵靠支撑元件112的近侧表面。
另外，柱形刀具76设置在环形阵列吻合钉容纳狭槽72和支撑元件112的径向内侧，支撑元件112与环形阵列吻合钉容纳狭槽72成叠置关系，从而不会延伸横跨柱形刀具76的刀具路径。通过这种方式，当致动手柄元件22时，整个支撑元件112被吻合至组织以加固所述组织，而不需要用柱形刀具76切断支撑元件112。
紧固元件被配置且定尺寸为接合多个周向布置的凸起，以将支撑部件稳固地定位于吻合装置的吻合钉钉仓部件上。例如，从支撑元件112向近侧延伸的多个周向布置的凸起120定位在钉仓组件70的远侧表面74上。见图3。更具体地，每个凸起120的近侧端在沿周向限定于钉仓组件70的外壁79中的凹槽71的近侧延伸。见图4。
紧固元件可以设置成环形圈130的形式，其固定至周向布置的凸起120周围，使得环形圈130施加径向向内的力于设置在凹槽71上面的凸起120。通过这种方式，环形圈130压在凹槽71上面，并且与设置在吻合钉钉仓组件70的外壁79上或者抵着外壁79的支撑元件112的一部分和/或凸起120基本齐平。这种配置使得支撑元件112能够相对于吻合钉钉仓组件70稳固地定位在适当位置。
环形圈130可以包括但不限于弹性带。例如，可以使用一片弹性金属（其形状可以是圆形）或一段缝合线材料、或类似的绑带、条带、缆线或者其他元件。
支撑部件110整体地形成为单个结构。但是，每个凸起120可以包括邻近支撑元件112的裂缝、穿孔或削弱线，由此吻合至组织的支撑元件112可以从多个凸起120被切断或分离。通过这种方式，凸起120可以通过环形圈130被至少局部地保持在凹槽71中，并且随后与手术吻合装置10一起从手术部位移除。
支撑元件112由生物相容材料（其是生物可吸收的或非生物可吸收的）以及天然或合成材料制成。应该理解的是，可以使用天然的、合成的、生物可吸收的以及非生物可吸收的材料的任意组合来形成支撑元件112。
另外，支撑元件112可以是有孔的、无孔的或它们的组合。还可以预期的是，此处描述的支撑元件112可以包含多个层，可以配置无孔层和有孔层的任意组合。例如，支撑元件112可以形成为包括以交替方式堆叠的多个无孔层和有孔层。在另一示例中，支撑元件112可以以“类三明治”方式形成，其中支撑元件112的外层包括有孔层，而内层是无孔层。多层式支撑元件的例子公开在2007年6月27日提交、公开号为2009/0001122、标题为“Buttressand Surgical Stapling Apparatus（支撑件和手术吻合装置）”的美国专利申请中，其整个公开通过引用并入此处。
尤其是，支撑元件112中使用无孔层可以加强支撑元件112在制造、运输、处理和吻合过程期间抵抗撕裂和穿孔的能力。另外，手术支撑件中使用无孔层还可以阻止或抑制组织从周边组织向内生长，从而充当粘附屏障以及抑制不想要的疤痕组织的形成。
另外，至少一种生物活性剂可以与支撑元件112结合。生物活性剂可以设置在手术支撑件的表面上和/或注入手术支撑件中。在这些实施例中，支撑元件112还能够用作输送生物活性剂的媒介。此处所使用的术语“生物活性剂”是在其最广义上使用，包括具有医疗用途的任何物质或物质的混合物。
现在参考图5至图7，还可以预想的是，手术支撑组件200可以包括支撑部件110和呈缝合线230形式的紧固元件。不同于手术支撑组件100，可以利用缝合线230将支撑部件110稳固地定位于吻合钉钉仓组件270的远侧表面274上。如以上描述的，当支撑元件112定位在吻合钉钉仓组件270的远侧表面274上时，每个凸起120的近侧端延伸横跨限定于钉仓组件270的外壁279中的凹槽271（图7）。
在使用中，缝合线230缠绕在周向布置的凸起120周围，使得缝合线230施加径向向内的力于凸起120的至少局部地横跨凹槽271的部分。尤其是，吻合钉钉仓组件270限定凹槽271，凹槽271具有拱形横截面轮廓以更好收纳压在凹槽271上面的缝合线230，如图7所示。这种配置使得支撑部件110能够相对吻合钉钉仓组件270稳固地定位在适当位置。
参考图8至图10，示出了手术吻合装置10在吻合术操作中使用以实现例如两个对置肠壁段的结合。典型地，吻合术操作是使用包括腹腔镜器件和装置的微创手术技术执行的。起初，移除病变肠壁段。之后，通过手术切口或经肛门（transanally）将砧座组件60插入操作部位，并且将砧座组件60定位在肠壁段“T1”内。将手术吻合装置10的包括吻合钉钉仓组件70的细长主体部30经肛门插入另一肠壁段“T2”。然后通过常规器件诸如荷包缝合线“P”（见图9）将肠壁段“T1”、“T2”暂时固定在它们相应的部件周围（例如，砧座组件60的轴64和细长主体部30的远侧端）。
此后，外科医生操纵砧座组件60，直到将轴64的近侧端插入并联接/连接至设置于手术吻合装置10的细长主体部30中的接近轴75的远侧端。轴64接合接近轴75以作为整体结构来操作。然后使砧座组件60和细长主体部30接近以使肠壁段“T1”、“T2”接近。然后发射手术吻合装置10，引起各个设置在相应吻合钉容纳狭槽72中的多个吻合钉推进器9将相应吻合钉7射出狭槽72。吻合钉7朝向砧座组件60行进穿过肠壁段“T1”、“T2”和支撑元件112，从而实现肠壁段“T1”、“T2”吻合至彼此，同时柱形刀具76切割设置在柱形刀具76径向内侧的一部分组织以完成吻合术。此时，凸起120保持联接到吻合至肠壁段“T1”、“T2”的支撑元件112上，并且通过环形圈130与吻合钉钉仓组件70固定在一起。当从手术部位移除手术吻合装置10时，邻近支撑元件112的裂缝或削弱线利于凸起120与吻合至肠壁段“T1”、“T2”的支撑元件112分离。
现在参考图11至图13，示出了根据本公开的另一实施例的支撑组件300。紧固元件呈缝合线330的形式。尤其是，支撑部件310包括：支撑元件312，其被配置且定尺寸为定位在吻合钉钉仓组件370的远侧表面374上；以及边缘320，其从支撑元件312的径向外缘向近侧延伸。边缘320接合吻合钉钉仓组件370的外壁379，由此支撑部件310包围吻合钉钉仓组件370的远侧表面374。柱形刀具376设置在支撑元件312的径向内侧，由此在这种配置下不需要用柱形刀具376切断支撑元件312。
边缘320包括多个周向布置的环圈315。每个环圈315被配置且定尺寸为收纳穿过其中的缝合线330。通过多个环圈315将缝合线330缠绕并系在边缘320周围使其抵靠吻合钉钉仓组件370的外壁379，以将支撑部件310固定于吻合钉钉仓组件370上。另外，边缘320包括邻近支撑元件312的周向限定的裂缝、多个穿孔或削弱线316，由此吻合至组织的支撑元件312可以与边缘320分离。通过这种方式，与支撑元件312分离的边缘320通过缝合线330保持固定至吻合钉钉仓组件370的外壁379，并且与吻合钉钉仓组件370一起从手术部位移除。可选择地，可以通过在边缘320中限定一对基本相邻的缝隙来创建每个环圈315。
参考图14至图16，示出了根据本公开的另一实施例的支撑组件400。支撑组件400包括支撑部件410和呈缝合线430形式的紧固元件。尤其是，支撑部件410包括：支撑元件412，其被配置且定尺寸为定位在吻合钉钉仓组件470的远侧表面474上；以及边缘420，其从支撑元件412的径向外缘向近侧延伸。边缘420接合吻合钉钉仓组件470的外壁479，由此支撑部件410包围吻合钉钉仓组件470的远侧表面474。
不同于边缘320，边缘420包括多个周向布置的开口、孔或钻孔415。每个钻孔415被配置且定尺寸为容纳穿过其中的缝合线430。通过多个钻孔415将缝合线430成环连结并系在边缘420周围，以将支撑部件410固定于吻合钉钉仓组件470上。另外，边缘420包括邻近支撑元件412沿周向限定的裂缝416，由此吻合至组织的支撑元件412可以与边缘420分离。通过这种方式，与支撑元件412分离的边缘420被固定至吻合钉钉仓组件470的外壁479，并且与吻合钉钉仓组件470一起从手术部位移除。
还可以预想到的是，每个钻孔415可以包括粘着剂或凝胶（诸如，水凝胶）以加强将缝合线430固定于钻孔415中。另外，还可以预期的是，缝合线430可以包括多个倒刺（例如，单向倒刺）以加强将缝合线430固定于钻孔415中。倒刺缝合线的示例公开在2009年1月29日提交的美国专利申请No.12/361,962中，其整个内容通过引用合并于此。复合倒刺缝合线是商业可获得的，如Tyco医疗健康集团公司（dba Covidien AG，曼斯菲尔德，马萨诸塞州）的V-LOCTM。
参考图17至图19，示出了根据本公开的另一实施例的支撑组件600。支撑组件600包括支撑元件610和从支撑元件610的径向外缘向近侧延伸的多个周向布置的凸起620。每个凸起620包括在其内壁或内表面625上的联接元件630a。
此外，吻合钉钉仓组件670的外壁679包括与凸起620上的联接元件630a对应的多个周向布置的联接元件630b。联接元件630a、630b可以包括例如可重紧固（refastenable）条带或钩和环紧固件。可选择地，凸起620可以包括双侧粘合条带以将支撑组件600可拆卸地定位至吻合钉钉仓组件670。
另外，还可以预期的是，每个凸起620可以包括裂缝、穿孔或削弱线616，由此吻合至组织的支撑元件610可以从凸起620被切断或分离。通过这种方式，凸起620可以通过联接元件630a、630b与吻合钉钉仓组件670固定于一起，并且与吻合钉钉仓组件670一起从手术部位移除。
现在参考图20至图22，还会想到的是，支撑组件700可以包括支撑元件710和从支撑元件710的径向内缘向近侧延伸的多个周向布置的凸起720，凸起720接合吻合钉钉仓组件770的内壁777。尤其是，每个凸起720包括在其外壁上的联接元件730a。此外，吻合钉钉仓组件770的内壁777包括与凸起720上的联接元件730a对应的多个周向布置的联接元件730b。联接元件730a、730b可以包括例如可重紧固条带或钩和环紧固件。
在这种配置下，柱形刀具776定位在沿周向布置于吻合钉钉仓组件770的内壁777上的联接元件730b的径向内侧，并定位在位于每个凸起720相应外壁上的联接元件730a的径向外侧。在这种配置下，柱形刀具776在联接元件730a、730b之间行进，并且从支撑元件710切断凸起720。另外，凸起720可以包括裂缝、穿孔或削弱线716以利于从支撑元件710切断凸起720。通过这种方式，吻合至组织的支撑元件710可以与凸起720分离。
参考图23和图24，示出了根据本公开的另一实施例的支撑组件800。不同于以上描述的支撑组件100、200、300、400、600、700，支撑组件800被配置为且适于与砧座组件60稳固地定位于一起。支撑组件800包括支撑部件810。使用缝合线830将支撑部件联接至吻合装置。支撑部件810包括：支撑元件812，其具有环形轮廓，被配置且定尺寸为当安装在砧座元件62上时与砧座元件62的外周缘齐平；以及从支撑元件812向远侧延伸的边缘820。另外，边缘820接合砧座元件62的外壁61，由此支撑部件810包围砧座元件62的近侧表面，砧座元件62限定了用于容纳和成形吻合钉7的多个穴。另外，支撑元件812限定了配置且定尺寸为容纳砧座组件60的轴64所通过的开口、孔或钻孔816。钻孔816被定尺寸为在轴64周围提供摩擦配合和紧配合。附加地或可替换地，还可以利用缝合线830来稳固地紧固支撑元件812至轴64。
参考图25和图26，在可替换实施例中，支撑组件900包括在外边缘920和内边缘940之间径向延伸的支撑元件912。尤其是，外边缘920被配置且定尺寸为接合砧座元件62的外壁61，并且内边缘940被配置且定尺寸为对砧座组件60的轴64提供紧配合或摩擦配合。通过这种方式，可最小化支撑组件900相对砧座组件60的径向和纵向移动。另外，呈缝合线930形式的紧固元件缠绕或系在抵靠砧座组件60的轴64的支撑元件912的内边缘940周围，以进一步将支撑组件900固定于砧座组件60上。
继续参考图25，支撑组件900可以与能够定位在吻合钉钉仓组件70的远侧表面74上的支撑组件100组合使用，还可以与上述支撑组件200、300、400、600、700中的任意一个组合使用。支撑组件100定位在柱形刀具76的径向外侧。这样，当致动手柄元件22时，整个支撑元件112被吻合至组织以加固组织，并且不需要用柱形刀具76切断支撑元件112。但是，柱形刀具76使与内边缘940和缠绕并系在内边缘940周围的缝合线930一起的支撑元件912的一部分去掉中心部分，从而从也吻合至组织的一部分支撑元件912释放上述这些部分。组件200、300、400、600、700、800、900的使用和操作基本类似于以上描述的支撑组件100的使用和操作，因而此处不再描述。
尽管在此参考附图已经描述了本公开的图示实施例，但是以上说明、公开和附图不应视为限制，而仅仅是作为特定实施例的示范例子。例如，包括有在内边缘940和外边缘920之间径向延伸的支撑元件912的支撑组件900可以被裁切而使用在吻合钉钉仓组件70的远侧表面74上。另外，支撑组件900还可以利用环形圈130或缝合线330来将支撑组件900的外边缘920稳固贴靠砧座组件60的外壁61。因此，应该理解的是，本公开不限于这些精确的实施例，此处本领域的技术人员可以实现各种其他变化和修改，而不会超出本公开的范围或精神。
Claims (8)
1.一种用于通过环形阵列的手术吻合钉来结合两个中空器官段的装置，所述装置包括：
吻合钉钉仓部件，其包括布置成环形阵列的多个手术吻合钉；
砧座部件，其能够相对于所述吻合钉钉仓部件在间隔位置和接近位置之间移动，以可调节地夹紧在所述吻合钉钉仓部件和所述砧座部件之间的器官段；
支撑部件，其被配置且定尺寸为定位在所述吻合钉钉仓部件的远侧表面上，所述支撑部件包括支撑元件和从所述支撑元件向近侧延伸的多个周向布置的凸起；以及
紧固元件，其被配置且定尺寸为接合所述多个周向布置的凸起，以将所述支撑部件稳固地定位于所述吻合钉钉仓部件上，
所述装置还包括同心地布置在所述吻合钉钉仓部件中以及与所述支撑元件同心地布置的刀具元件，所述刀具元件能够相对于所述吻合钉钉仓部件移动，
其中所述支撑元件被配置为设置在所述刀具元件的径向外侧。
2.根据权利要求1所述的装置，其中所述支撑元件具有环形配置，所述支撑元件同心地设置成与所述多个手术吻合钉成并置关系。
3.根据权利要求1所述的装置，其中所述紧固元件是环形圈，所述环形圈被配置且定尺寸为施加向内的力至抵靠所述吻合钉钉仓部件的外壁的所述多个周向布置的凸起。
4.根据权利要求1所述的装置，其中所述紧固元件是缝合线，所述缝合线系在抵靠所述吻合钉钉仓部件的外壁的所述多个周向布置的凸起周围。
5.根据权利要求1所述的装置，其中所述吻合钉钉仓部件的外壁限定了配置为且适于容纳所述多个周向布置的凸起的一部分的周向凹槽。
6.根据权利要求5所述的装置，其中所述紧固元件与所述周向凹槽配准。
7.根据权利要求1所述的装置，其中所述多个周向布置的凸起均限定邻近所述支撑元件的削弱线，以使得所述支撑元件能够与多个所述凸起分离。
8.根据权利要求1所述的装置，其中所述支撑部件被配置为使得所述多个周向布置的凸起接合所述吻合钉钉仓部件的内壁。
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2011
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2012
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| CA2795786A1 (en) | 2013-06-14 |
| EP2604195A1 (en) | 2013-06-19 |
| JP2013123643A (ja) | 2013-06-24 |
| EP2644128A1 (en) | 2013-10-02 |
| US9277922B2 (en) | 2016-03-08 |
| CN105962980A (zh) | 2016-09-28 |
| US20150164507A1 (en) | 2015-06-18 |
| EP2644128B1 (en) | 2020-05-13 |
| EP2644127A1 (en) | 2013-10-02 |
| US10321908B2 (en) | 2019-06-18 |
| EP2644127B1 (en) | 2018-07-11 |
| US20130153634A1 (en) | 2013-06-20 |
| US8967448B2 (en) | 2015-03-03 |
| CN106913364A (zh) | 2017-07-04 |
| EP2712556A1 (en) | 2014-04-02 |
| EP2712556B1 (en) | 2019-02-06 |
| US20150164506A1 (en) | 2015-06-18 |
| JP2017012904A (ja) | 2017-01-19 |
| JP6293234B2 (ja) | 2018-03-14 |
| CN103156659A (zh) | 2013-06-19 |
| JP6091179B2 (ja) | 2017-03-08 |
| ES2795819T3 (es) | 2020-11-24 |
| US9237893B2 (en) | 2016-01-19 |
| JP2017012905A (ja) | 2017-01-19 |
| CN106913364B (zh) | 2019-06-04 |
| US20160106430A1 (en) | 2016-04-21 |
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