CN101912285A - 手术用吻合装置 - Google Patents

手术用吻合装置 Download PDF

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CN101912285A
CN101912285A CN2010101452135A CN201010145213A CN101912285A CN 101912285 A CN101912285 A CN 101912285A CN 2010101452135 A CN2010101452135 A CN 2010101452135A CN 201010145213 A CN201010145213 A CN 201010145213A CN 101912285 A CN101912285 A CN 101912285A
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nail bin
anvil assembly
surgical stapling
bin groupware
stapling apparatus
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CN101912285B (zh
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李·奥尔森
厄尼·阿兰依
帕特里克·莫泽尔兹
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Covidien LP
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Tyco Healthcare Group LP
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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
    • 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
    • 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
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • 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
    • 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
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00—Metal working
    • Y10T29/49—Method of mechanical manufacture
    • Y10T29/49826—Assembling or joining

Abstract

本发明提供了一种与手术用吻合装置联用的装载单元，所述装载单元包括：工具组件，其具有彼此间能够移动的钉仓组件和砧座组件；手术用支撑件，其可释放地固定在所述砧座组件和/或钉仓组件的组织接触面上，其中，每一手术用支撑件均利用至少一个锚定件固定到所述砧座组件和/或钉仓组件；释放组件，其与所述砧座组件和/或钉仓组件相关联；以及驱动组件，其能够在近侧位置到远侧位置之间滑动地平移通过所述工具组件，其中，所述驱动组件致动释放组件，从而释放所述锚定件以使所述手术用支撑件脱离所述砧座组件和/或钉仓组件。

Description

手术用吻合装置
技术领域
本公开涉及一种包含有支撑材料(butress material)的手术用装置。本公开尤其涉及一种包括可拆卸的手术用支撑件(surgical buttress)的手术用吻合装置，和/或一种包括可拆卸的手术用支撑件的内窥镜手术用吻合装置。
背景技术
用于将组织抓紧或夹紧在对置的钳口结构之间，然后用手术用紧固件将组织连接起来的手术用设备，在现有技术中是公知的。在有些器械中设置有刀片，用来切割已由紧固件连接的组织。紧固件通常是手术用吻合钉的形式，但也可采用两件式聚合紧固件。
用于此种目的的器械可包括两个细长的钳口构件，这两个钳口构件分别用于抓取或夹紧组织。在某些手术用吻合器中，其中一个钳口构件具有装载了多个布置成至少两横排的吻合钉的吻合钉钉仓，而另一钳口构件具有砧座，在吻合钉从吻合钉钉仓被推出时，该砧座限定了用于形成吻合钉腿的表面。吻合操作是通过凸轮构件实现的，当凸轮构件纵向行进通过吻合钉钉仓时，对吻合钉推动器产生作用，从而顺序将吻合钉从吻合钉钉仓中射出。刀片可在吻合钉排之间行进，用来纵向切割和/或打开吻合钉排间被吻合起来的组织。这样的器械已被公开在例如第3,079,606号美国专利和第3,490,675号美国专利中。
在第3,499,591号美国专利中公开了另一种吻合器，该吻合器同样在手术切口的每一侧各施加两排吻合钉。该专利公开了一种具有一次性装载单元的手术用吻合器，在所述一次性装载单元中，凸轮构件移动通过两组交错的吻合钉携带槽之间的细长导向槽。吻合钉驱动构件位于携带槽内，并被定位成与纵向移动的凸轮构件互相接触，以便实现将吻合钉从一次性装载单元的吻合钉钉仓中射出。此类吻合器的其他例子公开在第4,429,695号美国专利和第5,065,929号美国专利中。
上述各种器械都设计用于外科医生能够直接用手进入手术部位的手术程序中。然而，在内窥镜或腹腔镜过程中，手术是通过皮肤上的小切口或通过由皮肤上的小进出创口插入的窄套管实施的。为满足内窥镜和或腹腔镜手术程序中的特殊需要，已经开发出了内窥镜手术用吻合设备，并公开在以下专利中：例如，第5,040,715号美国专利(格林(Green)等人)、第5,307,976号美国专利(奥尔森(Olson)等人)、第5,312,023号美国专利(格林等人)、第5,318,221号美国专利(格林等人)、第5,326,013号美国专利(格林等人)、第5,332,142号美国专利(罗宾逊(Robinson)等人)和第6,241,139号美国专利(米利曼(Milliman)等人)，这些专利的全部内容通过引用合并于此。
本申请的受让人Tyco医疗健康集团(Tyco Healthcare Group，LP)制造并销售内窥镜吻合器械(例如Multifire ENDO GIATM.30和Multifire ENDOGIATM.60器械)已有多年。这些器械包括手术用吻合装置以及装载单元。通常，在即将手术之前将装载单元连接到吻合装置上。在使用后，可将装载单元从吻合装置上移除，并可以把新的装载单元固定到吻合装置上以进行另外的吻合和或切割操作。这些器械提供了重要的临床益处。但仍需对这些装置加以改进。
当吻合较薄或者较脆组织时，重要的是要将吻合线(staple line)有效密封以免空气或液体泄漏。另外，通常有必要相对于组织加固吻合线以防止组织的撕裂或者吻合钉穿出组织。防止撕裂或穿出的一种方法涉及在吻合钉与其下面的组织之间放置生物相容的纤维加固材料或“支撑件(butress)”材料。在这一方法中，贴着组织放置一层支撑件材料，而组织则以传统方式吻合。在另一方法中，支撑件材料在吻合组织之前是定位在吻合装置上的。在第5,542,594号美国专利(麦基恩(McKean)等人)中公开了一个典型例子，该专利的全部内容通过引用合并于此。在麦基恩等人的专利中，管状支撑件材料在吻合器的钳口上滑动。然后吻合器被致动以吻合目标组织，并将支撑件材料固定在组织和吻合线之间以加固组织和吻合线。
发明内容
根据本公开，提供了一种手术用吻合装置，其包括：壳体；手柄，其由所述壳体支撑；细长体，其从所述壳体向远侧延伸；以及工具组件，其位于所述细长体的远端。所述工具组件具有一个钉仓组件和一个砧座组件，所述钉仓组件包括一个其中具有多个手术用紧固件的钉仓，其中，钉仓组件和砧座组件中的至少一个相对于钉仓组件和砧座组件中的另一个是可移动的，其中所述砧座组件包括砧座板，并且其中砧座板和吻合钉钉仓中的每一个均限定了细长的纵向狭槽。手术用吻合装置还包括：手术用支撑件，其可释放地固定在砧座板和吻合钉钉仓中的至少一个的组织接触面上，其中，每一手术用支撑件通过至少一个锚定件被固定在砧座组件和钉仓组件中的所述至少一个上；释放组件，其与砧座组件和钉仓组件中的所述至少一个相关联；以及驱动组件，其能够从近侧位置到远侧位置可滑动地平移通过所述工具组件，其中，所述驱动组件致动所述释放组件，从而释放所述锚定件且使所述手术用支撑件脱离砧座组件和钉仓组件中的所述至少一个。
所述释放组件在所述驱动组件的致动之前可夹住所述至少一个锚定件。
砧座组件和钉仓组件中的所述至少一个可以限定用于将所述至少一个锚定件的端部容纳于其中的侧向狭槽。
所述释放组件可包括：第一杆，在所述驱动组件的致动之前，第一杆延伸跨过所述纵向狭槽；以及第二杆，其连接到所述第一杆并且能被所述第一杆致动，在所述驱动组件的致动之前，第二杆的一个端部至少部分地延伸入所述侧向狭槽。
在使用中，随着所述驱动组件被推进到远侧位置，所述驱动组件可致动所述释放组件的第一杆，所述第一杆依次可致动所述释放组件的第二杆，从而释放布置在所述侧向狭槽中的锚定件。
砧座组件和钉仓组件中的每一个可包括释放组件。砧座组件和钉仓组件中的每一个可限定用于容纳每一手术用支撑件的锚定件的侧向狭槽。
每一释放组件可包括：第一杆，在所述驱动组件的致动之前，第一杆延伸跨过所述纵向狭槽；以及第二杆，其连接到所述第一杆并且能被所述第一杆致动，在所述驱动组件的致动之前，第二杆的一个端部至少部分地延伸入所述侧向狭槽。在使用中，随着所述驱动组件被推进到远侧位置，所述驱动组件可致动每个释放组件的第一杆，所述第一杆依次可致动每个释放组件的第二杆，以释放布置在每个所述侧向狭槽中的锚定件。
砧座组件和钉仓组件中的至少一个可包括收窄式的(constricting)且末端开口式的侧向狭槽，所述侧向狭槽被配置为夹住所述锚定件的端部，其中所述释放组件在所述驱动组件向远侧推进时可以将所述锚定件的端部推出所述侧向狭槽。
所述释放组件可包括推动器，所述推动器与保持所述锚定件的端部的所述侧向狭槽可操作地关联。通过一向远侧推进的驱动构件能够致动所述推动器，从而将所述锚定件的端部推出所述侧向狭槽。
所述释放组件的推动器可以是可枢转地连接到砧座组件和钉仓组件中的至少一个上，或者可滑动地支撑在砧座组件和钉仓组件中的至少一个上。
所述锚定件可以是与所述手术用支撑件及钉仓组件和砧座组件中的所述至少一个相接合的缝合线。所述锚定件可以是所述手术用支撑件的延伸部(extension)，其与所述至少一个钉仓组件及砧座组件相接合。
根据本申请的另一方案，提供了一种与手术用吻合装置联用的装载单元，其包括：工具组件，其具有一个钉仓组件和一个砧座组件，所述钉仓组件包括一个其中具有多个手术用紧固件的钉仓，钉仓组件和砧座组件中的至少一个相对于钉仓组件和砧座组件中的另一个是可移动的，其中所述砧座组件包括砧座板，并且其中砧座板和吻合钉钉仓中的每一个均限定了细长的纵向狭槽；手术用支撑件，其可释放地固定在砧座板和吻合钉钉仓中的至少一个的组织接触面上，其中，每一手术用支撑件通过至少一个锚定件被固定在砧座组件和钉仓组件中的所述至少一个上；释放组件，其与砧座组件和钉仓组件中的所述至少一个相关联；以及驱动组件，其能够从近侧位置到远侧位置可滑动地平移通过所述工具组件，所述驱动组件致动所述释放组件，从而释放所述锚定件且使所述手术用支撑件脱离砧座组件和钉仓组件中的所述至少一个。
所述释放组件在所述驱动组件的致动之前可夹住所述至少一个锚定件。
砧座组件和钉仓组件中的至少一个可限定用于将所述至少一个锚定件的端部容纳于其中的侧向狭槽。
所述释放组件可包括：第一杆，在所述驱动组件的致动之前，第一杆延伸跨过所述纵向狭槽；以及第二杆，其连接到所述第一杆并且能被所述第一杆致动，在所述驱动组件的致动之前，第二杆的一个端部至少部分地延伸入所述侧向狭槽。
在使用中，随着所述驱动组件被推进到远侧位置，所述驱动组件可致动所述释放组件的第一杆，所述第一杆依次可致动所述释放组件的第二杆，从而释放布置在所述侧向狭槽中的锚定件。
每一砧座组件和钉仓组件可包括释放组件。
砧座组件和钉仓组件中的至少一个可包括收窄式的且末端开口式的侧向狭槽，所述侧向狭槽被配置为夹住布置于其中的所述锚定件的端部，其中，所述释放组件在所述驱动组件向远侧推进时可以将所述锚定件的端部推出所述侧向狭槽。
在随后结合附图的说明中，本申请其它的有益之处将得以清晰展现。
附图说明
下面将参考附图，对本公开进行进一步地描述；不同的视图中的相似部件用相似的附图标记标识，其中：
图1是根据本公开的一个实施例的手术用吻合装置的立体图；
图2是图1所示手术用吻合装置的装载单元的远端的部件分解的俯视立体图；
图2A是装载单元的砧座组件的远端的放大立体图，图示了一个手术用砧座支撑件可操作地固定在所述砧座组件的组织接触面上；
图2B是装载单元的钉仓组件的放大立体图，图示了一个手术用钉仓支撑件可操作地固定在所述钉仓组件的组织接触面上；
图3是装载单元的砧座组件远端的俯视立体图，其中，该装载单元包括根据本公开一个实施例的缝合线释放组件，示出了缝合线释放组件处于打开结构；
图4是图3所示砧座组件的俯视立体图，以部件分解的方式示出了其缝合线释放组件的部件；
图5是图3与图4所示的砧座组件的仰视立体图；
图6是图3-5所示的砧座组件的俯视平面图，图示了砧座组件的缝合线释放组件处于闭合结构；
图7是图6所示的砧座组件在移除了保持器后的俯视平面图；
图8是图3-7所示的砧座组件的俯视平面图，图示了砧座组件的缝合线释放组件处于打开结构；
图9是图8所示的砧座组件在移除了保持器后的俯视平面图；
图10是DLU的钉仓组件的远端的俯视立体图，其中的DLU包括根据本公开一个实施例的缝合线释放组件；
图11是图10所示钉仓组件的俯视立体图，以部件分解的方式示出了其缝合线释放组件的部件；
图12是图10与图11所示钉仓组件的远端的仰视立体图；
图13是图10-12所示的钉仓组件的俯视平面图，图示了钉仓组件的缝合线释放组件处于闭合结构；
图14是图10-13所示钉仓组件的俯视立体图，图示了钉仓组件的缝合线释放组件处于打开结构；
图15是包括了根据本公开另一实施例的缝合线释放组件的装载单元的远端的立体图；
图16是图15中显示的细节区域的放大视图；
图17是一个砧座组件(移除了砧座盖)的远端的俯视立体图，图示了该砧座组件的缝合线释放组件处于被致动结构；
图18是图17所示砧座组件的远端的俯视立体图，其以部件分解的方式示出了其缝合线释放组件的部件；
图19是图17与图18所示的砧座组件的俯视平面图，图示了砧座组件的缝合线释放组件处于未致动结构；
图20是图17-19所示的砧座组件的俯视平面图，图示了砧座组件的缝合线释放组件处于被致动结构；
图21是图15所示DLU的钉仓组件的远端的仰视立体图，并示出了从该钉仓组件分离出来的缝合线释放组件；
图22是图21所示的缝合线释放组件的俯视立体图；
图23是图21与图22所示的缝合线释放组件的部件分解的仰视立体图；
图24是图21-23所示的缝合线释放组件的俯视平面图，图示了处于未致动结构的缝合线释放组件；
图25是图21-24所示的缝合线释放组件的俯视平面图，图示了处于被致动结构的缝合线释放组件；
图26是装载单元的砧座组件的远端的俯视立体图，其中该装载单元包括根据本公开另一个实施例的缝合线释放组件；
图27是图26所示砧座组件的远端的部件分解的俯视立体图；
图28是图26与图27所示砧座组件的远端的俯视立体图，图示了处于未致动结构的缝合线释放组件；
图29是图26-28所示砧座组件的远端的俯视立体图，图示了处于被致动结构的缝合线释放组件；
图30是装载单元的砧座组件的远端的俯视立体图，其中该装载单元包括根据本公开又一个实施例的缝合线释放组件，示出的缝合线释放组件处于未致动结构；
图31是图30所示砧座组件的远端的俯视立体图，图示了处于被致动结构的缝合线释放组件；
图32是装载单元的钉仓组件的远端的俯视立体图，其中该装载单元包括根据本公开再一个实施例的缝合线释放组件；
图33是图32所示缝合线释放组件的俯视立体图；
图34是图32与图33所示的缝合线释放组件的俯视立体图；
图35是图32-34所示的缝合线释放组件的部件分解的仰视立体图；
图36是图32-35所示的缝合线释放组件的部件分解的仰视立体图；
图37是图32-36所示的缝合线释放组件的俯视平面图，图示了处于未致动结构的缝合线释放组件；以及
图38是图32-37所示的缝合线释放组件的俯视平面图，图示了处于被致动结构的缝合线释放组件。
具体实施方式
现在，将参照附图，详细描述在此公开的手术用吻合装置及装载单元的各实施例，在每一不同附图中，相似的附图标记表示相同或相应的元件。
在下面的附图及说明中，按照惯例，术语“近侧”是指吻合装置靠近操作者的一端，而术语“远侧”则是指装置远离操作者的那一端。
图1示出了一般被标识为10的手术用装置，例如手术用吻合装置。为简便起见，本公开将主要关注所述手术用吻合装置10的工具组件。对于手术用吻合装置10的其他构件及使用方法的详细讨论公开在第6,241,139号美国专利中，该专利的公开内容通过引用合并于此。
手术用吻合装置10是一种内窥镜装置，其包括手柄组件12以及从该手柄组件12伸出的细长体14。装载单元16可释放地固定在细长体14的远端。另外，本公开考虑到了具有容纳在该装置的钳口中的可替换钉仓的手术用吻合装置。
装载单元16包括工具组件17，工具组件具有用于容纳多个手术用紧固件或手术用吻合钉84(参见图2)的钉仓组件18，以及与钉仓组件呈并置关系固定的砧座组件20，其中，砧座组件20与钉仓组件18能够彼此移近或移离，从而关闭或打开工具组件17。如此间所示，装载单元16被配置成施加六直排吻合钉，装载单元的长度约为30mm至约60mm。也可以想象，用于施加任意排数的吻合钉、具有以各种方式布置的吻合钉坑的装载单元，和/或具有任何其它长度(例如45mm)的装载单元和末端执行器。手柄组件12包括固定手柄构件22、活动手柄构件24以及筒形部26。
旋转构件28安装在筒形部26的前端，以利于细长体14以及相连的装载单元16相对于手柄组件12的旋转。铰接杠杆30也安装在筒形部26的前端，并与旋转构件28相邻，以利于工具组件17的铰接。优选地，一对旋钮32沿着筒形部26可移动地安置。旋钮32向远侧推进以使钉仓和/或砧座组件18、20相接近或闭合，旋钮32向近侧收回则使钉仓和/或砧座组件18、20相分离或打开。
装载单元16理想地为可选择性去除地结合至细长体14。装载单元16包括壳体部36，壳体部36具有适于与细长体14的远端可释放地接合的近端。安装组件38在“P”处被可枢转地安装在壳体部36的远端，并且被配置为容纳工具组件17的近端，以使得工具组件17围绕“P”处的轴(该轴垂直于壳体部36的纵轴)的枢转运动实现工具组件17的铰接。
大致参见图2，装载单元16包括安装组件40。安装组件40包括上安装部40a和下安装部40b。轴向驱动组件50与钉仓组件18和/或砧座组件20可操作地相关联，并可滑动地布置在钉仓组件18和砧座组件20之间。参见图2，轴向驱动组件50包括具有远端54及近端56的细长的驱动梁52。驱动梁52可由单片材料，或者优选由多片层叠材料制成。
驱动组件50的驱动梁52的近端56包括用于容纳推动器的一对弹性接合指状部。推动器被定尺寸并配置为：在装载单元16的近端与手术用吻合装置10的细长体14相接合时，推动器可装配地(mountingly)接合驱动部件，例如驱动杆或控制杆(未示出)。控制杆的功能是从手柄组件12向驱动组件50传递轴向运动。
驱动组件50的驱动梁52的远端54包括头部60，该头部60具有横向伸展的上部64a、横向伸展的下部64b以及中央壁部62。中央壁部62的远侧边限定了刀片等66。
如图2所示，砧座组件20包括具有多个吻合钉变形坑/腔(未示出)的砧座板70以及固定在砧座板70顶表面的盖板72，在砧座板70和盖板72之间限定有空腔(未示出)。限定在砧座板70和盖板72之间的空腔被定尺寸为将头部60的上部64a容纳于其中。纵向狭槽70b贯穿砧座板70以利于头部60的中央壁部62通过其中。另外，盖板72限定了形成于其中的一对对置的凹槽72a，当盖板72与砧座板70装配在一起时，该对凹槽72a与形成于砧座板70中的近侧凹槽对70d彼此对齐。
继续参考图2，砧座板70限定了近侧凹槽对70d，该近侧凹槽对70d靠近砧座板70的近端形成，并且其中的每一个凹槽分别布置在纵向狭槽70b相对的两侧。砧座板70限定了远侧凹槽对70e，该远侧凹槽对70e靠近砧座板70的远端形成，并且其中的每一个凹槽分别布置在纵向狭槽70b相对的两侧。在一个实施例中，近侧凹槽对70d和远侧凹槽对70e中的每一对的至少一个凹槽优选是非圆形的和收窄式的，或者具有渐缩的宽度尺寸，以便与锚定件“S”摩擦接合和/或夹紧锚定件“S”。
在此所用的术语“锚定件”应理解为包括但并不限于缝合线、细线、系绳、链带、绑带、绳子、金属丝、缆索、紧固件、大头钉或任何适合于此公开之预期目的其他材料。在一些实施例中，锚定件是下面讨论的吻合线加固材料的延伸部。锚定件可包括吻合线加固材料的一个一体部分，或者可由与吻合线加固材料相同或类似的材料形成并连到吻合线加固材料上。
如图2与图2A所示，砧座组件20进一步包括手术用砧座支撑件“B1”、小拭子等，手术用砧座支撑件“B1”、小拭子等通过锚定件“S”可操作地固定在砧座板70的下表面或者组织接触面上，以覆盖至少一些砧座坑70a和/或覆盖纵向狭槽70b的至少一部分长度。特别地，一个锚定件“S”被包绕在手术用砧座支撑件“B1”的近侧部并被系入近侧凹槽对70d的每一凹槽中，而一个锚定件“S”被包绕在手术用砧座支撑件“B1”的远侧部并被系入远侧凹槽对70e中的每一凹槽中。
手术用砧座支撑件“B1”包括：形成于其侧边中并与砧座板70的近侧凹槽对70d对齐的近侧槽口对；形成于其侧边中并与砧座板70的远侧凹槽对70e对齐的远侧槽口对；以及形成于其近端边中并在手术用砧座支撑件“B1”固定到砧座组件20时能够与纵向狭槽70b对齐的近端槽口。手术用砧座支撑件“B1”进一步包括从其远端边伸出的舌状部或突出部，以利于在装配过程中使手术用砧座支撑件“B1”连到砧座组件20上。已考虑到，在手术用砧座支撑件“B1”固定到砧座组件20之后以及包装或装运之前，舌状部可从手术用砧座支撑件“B1”移除。
如图2至图9所示，砧座组件20进一步包括释放组件74，该释放组件74布置在砧座板70和盖板72之间，位于与远侧凹槽对70e操作地对准(operative registration)的位置处。释放组件74包括引导板75，引导板75限定了一个穿过其形成的弓形狭槽75a。狭槽75a被配置并定尺寸为容纳穿过其的工具(未示出)。狭槽75a的功能和目的将在下文中详细讨论。
释放组件74进一步包括可枢转地连接到砧座板70(如图4和图5所示)和/或(可选择地)盖板72(如图2所示)的锁杆或锚杆76。锚杆76包括主体部76a，主体部76a在其中限定了一细长通道或狭槽76b并限定了从其边缘伸出的指状部76c。指状部76c与远侧凹槽对70e中的一个凹槽，优选为远侧凹槽对70e中具有相对较大宽度尺寸的那一个凹槽操作地对准。
释放组件74进一步包括可枢转地连接到砧座板70(如图4和图5所示)和/或(可选择地)盖板72(如图2所示)的锚杆致动件77。致动件77包括偏心凸轮77a，偏心凸轮77a限定了一中央旋转轴，致动件77可围绕中央旋转轴旋转。致动件77包括块状部或凸出部77b，该块状部或凸出部77b从偏心凸轮77a的表面沿基本平行于偏心凸轮77a的中央旋转轴且偏离开该中央旋转轴一径向距离的方向延伸。凸出部77b可滑动且可旋转地布置在锚杆76的细长狭槽76b中。致动件77进一步包括释放杆77c，释放杆77c以与偏心凸轮77a基本相切的方式从与凸出部77b基本相对的那一侧延伸出。释放杆77c限定了形成在它上的销钉77d，该销钉77d与引导板75的弓形狭槽75a对准。在操作中，随着偏心凸轮77a旋转，释放杆77c的销钉77d会沿着引导板75的弓形狭槽75a的路径跟进。
如图6与图7所示，缝合线释放组件74包括锁定或锚定结构，其中，锚杆76的指状部76c延伸入远侧凹槽对70e中与其操作地对准的相应的那一个凹槽或压在那一个凹槽上，致动件77的释放杆77c延伸跨过砧座板70的刀片狭槽70b，而且释放杆77c的销钉77d布置在引导板75的弓形狭槽75a的第一端，或者布置在该第一端的附近。并已考虑到，缝合线释放组件74可具有摩擦配合或压紧配合特性，以便能够在手术用吻合装置10制造/装配之后直到完成发射之前的整个时期内均使缝合线释放组件74维持和/或保持处于锁定或锚定结构。
如图8与图9所示，缝合线释放组件74包括打开或释放结构，其中，锚杆76的指状部76c并不延伸入远侧凹槽对70e中与其操作地对准的相应的那一个凹槽或压在那一个凹槽上，致动件77的释放杆77c并不延伸跨过砧座板70的刀片狭槽70b，而释放杆77c的销钉77d布置在引导板75的弓形狭槽75a的第二端，或者布置在该第二端的附近。
在手术用吻合装置10的装配过程中，制造人员利用缝合线释放组件74来将手术用砧座支撑件“B”连同手术缝合线或系绳一起固定到砧座板70的组织接触面上；手术用吻合装置10的最终用户则利用它来在手术用吻合装置10完成发射时将手术用砧座支撑件“B”从砧座板70的组织接触面上自动释放或脱离。
参考图6至图9，在制造过程中，在缝合线释放组件74处于打开或释放结构(图8和图9)的情况下，手术用砧座支撑件“B”被置于砧座板70的组织接触面上。接着，手术用缝合线“S1”的第一端被插入到远侧凹槽对70e的一个凹槽中，而手术用缝合线“S1”的第二端延伸跨过手术用砧座支撑件“B1”(参见图2)，并被插入到远侧凹槽对70e的另一凹槽中。并已考虑到，手术用缝合线“S1”的第一端可包括被定大小为不会穿通远侧凹槽对70e中较窄的那一凹槽的结块、止动件等(未示出)。
在手术用缝合线“S1”的第二端布置在远侧凹槽对70e中的情况下，并且在手术用缝合线“S1”被牵拉跨过手术用砧座支撑件“B”的情况下，一个工具(未示出)通过引导板75的弓形狭槽75a插入而与设置在释放杆77c的销钉77d中的开口相接合。参考图6与图7，然后操纵该工具以使其移动通过引导板75的弓形狭槽75a，或者沿着引导板75的弓形狭槽75a移动，从而使释放杆77c致动或移动，并使偏心凸轮77a旋转。随着偏心凸轮77a旋转，凸出部77b围绕偏心凸轮77a的枢转轴旋转并作用于锚杆76的细长狭槽76b的壁，从而使锚杆76枢转。随着锚杆76枢转，会使其指状部76c延伸入远侧凹槽对70e中的一个凹槽或压在该一个凹槽上，并夹紧布置于其中的手术用缝合线的第二端。同时，释放杆77c已被移动到一个延伸跨过砧座板70的刀片狭槽70b的位置。如前所述，缝合线释放组件74现在已处于锁定或锚定结构。与指状部76c协作的远侧凹槽70e理想地是相对宽的，从而使缝合线“S1”在锚杆76离开凹槽70e时能够容易地穿入、穿出凹槽70e。布置在砧座板70相对的横向侧上的另一远侧凹槽70e可以是相同的尺寸，或者是尺寸足够小以系住缝合线“S1”并将缝合线保持在适当位置以利于装配。
在操作中，在手术用砧座支撑件“B1”固定砧座板70的下表面上的情况下，在手术用吻合装置10发射期间，随着驱动组件50被推进(也就是，从最近侧位置移向最远侧位置)，刀片66切穿近侧缝合线“S2”的中间部分，由此将手术用砧座支撑件“B1”的近端从砧座组件20上脱离。在使用中，如图9所示，在手术用吻合装置10的发射行程接近完成时且驱动组件50接近砧座板70的刀片狭槽70b的远端时，驱动组件50接触释放杆77c并推动释放杆77c以及依次推动偏心凸轮77a围绕其枢转轴旋转。随着偏心凸轮77a旋转，凸出部77b围绕偏心凸轮77a的枢转轴旋转并作用在锚杆76的细长狭槽76b的壁上，从而使锚杆76枢转。随着锚杆76枢转，会使其指状部76c移离相对较宽的远侧凹槽70e，并释放布置于其中的手术用缝合线“S”的第二端。在手术用缝合线“S”的第二端被释放或脱离的情况下，手术用砧座支撑件“B1”的远端是自由的以从与砧座板70的组织接触面分离。
如图1与图2所示，钉仓组件18包括一个限定了细长支承通道80a的支架80。支架80的细长支承通道80a把吻合钉钉仓82容纳于其中。沿着吻合钉钉仓82和支架80形成的相应突出部与狭槽的功能在于将吻合钉钉仓82保持在支架80内。形成在吻合钉钉仓82上并从该钉仓延伸而出的一对支撑杆设置为搁置在支架80的侧壁上，从而进一步将吻合钉钉仓82稳固在支架80的支承通道80a中。吻合钉钉仓82包括形成于其中的保持狭槽82a，该保持狭槽用于容纳多个紧固件84与推动器86。多个间隔开的纵向狭槽82b贯穿吻合钉钉仓82以容纳致动滑块90的直立凸轮楔块90a。该致动滑块90包括中央直立楔块或壁90b。中央壁90b限定了一个形成于其中的远侧槽口或肩部90c(参见图2)。
中央纵向狭槽82c形成在吻合钉钉仓82中并沿着吻合钉钉仓82的长度延伸，以利于头部60的中央壁部62的通过。在手术用吻合器10操作过程中，致动滑块90平移通过吻合钉钉仓82的纵向狭槽82b，以推进凸轮楔块90a与推动器92顺次接触，从而使推动器92在保持狭槽82a中垂直平移并推动紧固件84(例如吻合钉)从狭槽82a进入到砧座组件20的砧座板70的吻合钉成形腔70a中。
继续参考图1和图2，吻合钉钉仓82限定一近侧凹槽对82e，该近侧凹槽对82e靠近吻合钉钉仓82的近端形成，并且其中的每一个凹槽分别布置在纵向狭槽82c相对的两侧。吻合钉钉仓82进一步限定了一远侧凹槽对82f，该远侧凹槽对82f靠近吻合钉钉仓的远端形成，并且其中的每一个凹槽分别布置在纵向狭槽82c相对的两侧。在一个实施例中，近侧凹槽对82e与远侧凹槽对82f中的每一对的至少一个凹槽优选是非圆形的和收窄式的，或者安排成能够与锚定件“S”摩擦接合和/或夹紧锚定件“S”。
如图1与图2B所示，钉仓组件18进一步包括手术用钉仓支撑件“B2”、外科用纱布等，手术用钉仓支撑件“B2”、外科用纱布等通过锚定件“S3”和“S4”可操作地固定在吻合钉钉仓82的上表面或者组织接触面上，以覆盖至少一些吻合钉坑82a和/或覆盖纵向狭槽82c的至少一部分长度。特别地，锚定件“S4”被包绕在手术用钉仓支撑件“B2”的近侧部并被系入近侧凹槽对82e的每一凹槽中，锚定件“S3”被包绕在手术用钉仓支撑件“B2”的远侧部并被系入远侧凹槽对82f的每一凹槽中。
在一个具体实施例中，每一锚定件“S”的第一端包括被定大小为不会穿通近侧凹槽对82e的一个凹槽的结块、止动件等(未示出)，每一锚定件“S”的第二端绕过且横跨手术用钉仓支撑件“B2”至少一次，并返回穿过近侧凹槽对82e的另一凹槽。例如，每一锚定件“S”的第二端可被夹入或系入近侧凹槽对82e的另一凹槽中，从而将该锚定件“S”的第二端锚定，并将手术用钉仓支撑件“B2”固定在吻合钉钉仓82的组织接触面上。类似地，锚定件“S3”被用于横向延伸跨过手术用钉仓支撑件“B2”，并与远侧凹槽对82f接合。
在另一实施例中，释放组件被布置为切断缝合线“S”。引导板75上的弓形狭槽75a沿反方向延伸，使得其被布置为将锚杆95向缝合线“S”驱动。锚杆76的面向缝合线S的表面包括锋利的边缘，其在被驱动组件致动时切断缝合线。
手术用钉仓支撑件“B2”包括：形成在其侧边中且与吻合钉钉仓82的近侧凹槽对82e对齐的近侧槽口对；形成在其侧边中且与吻合钉钉仓82的远侧凹槽对82f对齐的近侧槽口对；以及形成在其近端边中并在手术用钉仓支撑件“B2”固定到钉仓组件18时能够与纵向狭槽82c对齐的近侧槽口。手术用钉仓支撑件“B2”进一步包括从其远端边伸出的舌状部或突出部，以利于在装配过程中使手术用钉仓支撑件“B2”连到吻合钉钉仓82上。已考虑到，手术用钉仓支撑件“B2”的宽度在其近端部可以减小。还进一步考虑到，在手术用钉仓支撑件“B2”固定到吻合钉钉仓82之后以及包装或装运之前，舌状部可从手术用钉仓支撑件“B2”移除。
如图2以及图10至图14所示，钉仓组件18进一步包括钉仓释放组件94，该钉仓释放组件94被支撑在吻合钉钉仓82中，靠近吻合钉钉仓82的远端。释放组件94包括一个与吻合钉钉仓82可枢转地连接的锁杆或锚杆95。锚杆95包括：主体部95a，主体部具有从边缘延伸出的指状部95b。指状部95b与远侧凹槽对82f中的一个凹槽，优选为该远侧凹槽对中具有相对较大宽度尺寸的那一个凹槽操作地对准。
释放组件94进一步包括一个与锚杆95可枢转地连接的锚杆致动件97(参见图11和图12)。致动件97包括：第一凸轮面97a，其沿着致动件97的近端边定位并且延伸跨过吻合钉钉仓82的中央纵向狭槽82c；第二偏心凸轮面97b，其从致动件97向远侧横向地延伸以靠近远侧凹槽对82f中的与锚杆95的指状部95b可操作地关联的那一个凹槽。致动件97的第一凸轮面97a基本呈弓形或凸面形。致动件97限定了一孔或开口97c，该开口97c被配置及定尺寸为将锚杆95的销钉95c容纳在其中，从而使锚杆95与致动件97相对于彼此枢转或旋转。
在操作中，致动件97绕其枢转轴点沿第一方向的旋转引起第二凸轮面97b压向吻合钉钉仓82的表面82g(参见图13和图14)，因此使指状部95b至少部分地移动通过和/或横跨远侧凹槽对82f中与该指状部相关联的那一个凹槽。
如图13所示，缝合线释放组件94包括锁定或锚定结构，其中，致动件97的第一凸轮面97a延伸入并跨过吻合钉钉仓82的纵向狭槽82c，其中致动件97的第二凸轮面97b被压向吻合钉钉仓82的表面82g，因此，锚杆95的指状部95b延伸入远侧凹槽对82f中与其操作地对准的相应的那一个凹槽或压在那一个凹槽上。紧固件释放组件94可以通过偏置部件或止动件而维持其锁定或锚定结构，其中偏置部件或止动件以使致动件97保持处于锁定或锚定结构的方式与致动件97相接合。在处于这样一个锁定或锚定结构中时，可驱使缝合线“S3”进入吻合钉钉仓82的凹槽82f中。并已考虑到，缝合线释放组件94可具有摩擦配合或压紧配合特性，以便能够在手术用吻合装置10制造/装配之后直到完成发射之前的整个时期内均将缝合线释放组件94维持和/或保持处于锁定或锚定结构。
如图12和14所示，缝合线释放组件94包括打开或释放结构，其中，锚杆95的指状部95b并不延伸入远侧凹槽对82f中与其操作地对准的相应的那一个凹槽或压在那一个凹槽上，致动件97的第一凸轮面97a并不延伸入并跨过吻合钉钉仓82的中央纵向狭槽82c，致动件97的第二凸轮面97b也不压向吻合钉钉仓82的表面82g。
在手术用吻合装置10的装配过程中，制造人员利用缝合线释放组件94来将手术用钉仓支撑件“B2”连同锚定件、手术用缝合线或系绳一起(参见图2)固定到吻合钉钉仓82的组织接触面上；手术用吻合装置10的最终用户则利用它来在手术用吻合装置10完成发射时将手术用钉仓支撑件“B2”从吻合钉钉仓82的组织接触面上自动释放或脱离。
参考图10至图14，在制造过程中，在缝合线释放组件94处于打开或释放结构中的情况下，手术用钉仓支撑件“B2”被置于吻合钉钉仓82的组织接触面上。接着，手术用缝合线“S”的第一端被插入到远侧凹槽对82f中相对较窄的凹槽中，而手术用缝合线“S”的第二端延伸跨过手术用钉仓支撑件“B2”，并插入远侧凹槽对82f中相对较宽的凹槽中。并已考虑到，手术用缝合线“S”的第一端可包括被定大小为不会穿通远侧凹槽对82f中较窄的那一凹槽的结块、止动件等(未示出)。
如图11所示，吻合钉钉仓82包括形成于其中的进入开口83，该进入开口83用于在其中插入并容纳缝合线释放组件94，并为致动件97提供通路。在手术用缝合线“S”的第二端布置在远侧凹槽对82f中的较宽凹槽中的情况下，并且手术用缝合线“S”被牵拉跨过手术用钉仓支撑件“B2”的情况下，致动件97围绕枢转轴旋转，从而使致动件97的第一凸轮面97a延伸入并跨过吻合钉钉仓82的中央纵向狭槽82c，并且使致动件97的第二凸轮面97b压向吻合钉钉仓82的表面82g(参见图13和图14)。通过这种方式，锚杆95枢转一定量，该量足以使锚杆95的指状部95b延伸入远侧凹槽对82f中与其相对准的相应的那一个凹槽或压在那一个凹槽上，由此夹住布置在其中的手术用缝合线的第二端。如前所述，缝合线释放组件94此时处在锁定或锚定结构中。
在操作中，在手术用钉仓支撑件“B1”被固定在吻合钉钉仓82的组织接触面的情况下，在手术用吻合装置10发射期间，随着驱动组件50被推进(也就是，从最近侧位置移向最远侧位置)，刀片66切穿近侧缝合线“S4”的中间部分，由此将手术用钉仓支撑件“B2”的近端从吻合钉钉仓82上脱离。在使用中，如图14所示，在手术用吻合装置10的发射行程接近完成时，且驱动组件50接近吻合钉钉仓82的中央纵向狭槽82c的远端时，驱动组件50接触致动件97的第一凸轮面97a，推动致动件97旋转。致动件97的第二凸轮面97b也围绕其枢销95c的枢转轴旋转。随着偏心第二凸轮面97b绕第二凸轮面97b的枢转轴旋转，枢销95c与吻合钉钉仓82的表面82g之间的距离减小，由此使得锚杆95围绕枢销95c枢转。随着锚杆95枢转，会使其指状部95c移离相对较宽的远侧凹槽82f，并释放布置于其中的手术用缝合线“S”的第二端。在手术用缝合线“S”的第二端被释放或脱离的情况下，手术用钉仓支撑件“B2”的远端是自由的以从吻合钉钉仓82的组织接触面分离。与锚杆95的指状部95b操作地对准的远侧凹槽82f被定尺寸为使得缝合线“S3”即便在锚杆95旋转的情况下仍然不能系入该凹槽82f中。
随着驱动组件50被从近侧位置向远侧位置推进，其刀片66纵向切穿或割穿手术用砧座支撑件“B1”与手术用钉仓支撑件“B2”二者，由此将支撑件“B1，B2”大体上分割成两半。另外，随着驱动组件50被从最近侧位置向最远侧位置推进，致动滑块90的直立凸轮楔块90a使推动器92致动，使得推动器92在保持狭槽82a中沿垂向平移，并且从狭槽82a中推动紧固件84。随着紧固件84(例如吻合钉)被从吻合钉钉仓82的狭槽82a中推动，紧固件84的支腿刺穿并穿过手术用砧座支撑件“B1”与手术用钉仓支撑件“B2”二者，穿过插在手术用砧座支撑件“B1”与手术用钉仓支撑件“B2”之间的任何组织(未示出)，并且紧靠砧座组件20的砧座板70的吻合钉成形腔70a形成或形成在该吻合钉变形腔70a内。支撑件“B1，B2”优选包括穿孔，穿孔可分隔支撑件并利于从组织移除该装置。
根据本公开，手术用砧座支撑件“B1”和/或手术用钉仓支撑件“B2”是分别预装(也就是由生产者预装)在装载单元16的砧座组件20或钉仓组件18上的。在装载单元发射之后，其他未发射的装载单元(具有或没有支撑件“B”)能够被装入到手术用装置上。在一些实施例中，可替换的装载单元是一个能够被插入支架80的支承通道中的可移除式钉仓。支撑件以及释放组件可被预装到该可移除式钉仓上，并可以为手术用装置的用户提供用来将支撑件装到砧座组件上的设备。例如，可采用具有粘合剂的支撑件。用于砧座组件20和/或钉仓组件18的额外的或者可替换的支撑件“B”可以根据需要或要求固定到砧座组件20或者钉仓组件18上。
在另一实施例中，释放组件可被布置为用于切割缝合线“S”。致动件97上的凸轮面97b可被布置为使锚杆95朝向缝合线“S”凸轮运动。锚杆75的面向缝合线“S”的表面可包括锋利的边缘，其可以在被驱动组件致动时切割缝合线。
现在转向图15至图25，根据本公开另一实施例的用于手术用吻合装置10的装载单元被标识为116。装载单元116与装载单元16大体上相似，在此只对两者在构造与操作中需要加以区别的部分进行详细讨论。
如图15至图20所示，装载单元116的砧座组件120包括缝合线释放组件174，该释放组件174布置在砧座板170和盖板172之间，位于与远侧凹槽对170e操作地对准的位置处。缝合线释放组件174包括可枢转地连接到砧座板170(参见图18)和/或(可选择地)盖板172上的连杆臂175。连杆臂175包括主体部175a，该主体部限定了坑或凹槽175c和凸轮面175d，凹槽175c形成在该主体部的第一侧边175b中，凸轮面175d大体上沿着其毗邻侧边或近侧边限定。坑175c具有大体上呈弓形、圆形或导圆角的轮廓。如图18和图20所示，连杆臂175包括枢销175e，该枢销175e从主体部175a伸出，用于将连杆臂175可枢转地连接到砧座组件120上。
释放组件174进一步包括推动杆177，该推动杆可枢转地连接到连杆臂175上，并且可滑动地布置在砧座板170与盖板172之间。推动杆177包括大体上呈矩形结构的主体部177a以及从该主体部177a的一个角上延伸而出的头部177b，头部177b具有大体圆形的或导圆角的结构。推动杆177的头部177b被配置及定尺寸为，用于可枢转和/或可旋转地连接到连杆臂175的坑175c中。
如图19所示，缝合线释放组件174包括未致动结构，其中，推动杆177并不延伸入远侧凹槽对170e中的与其操作地对准的一个相应凹槽或压在该一个相应凹槽上，连杆臂175的纵向轴定向为与装载单元116的纵向轴大体平行。并已考虑到，缝合线释放组件174可具有摩擦配合或压紧配合特性，以便能够在手术用吻合装置制造/装配之后直到完成发射之前的整个时期内均将缝合线释放组件74维持和/或保持处于锁定或锚定结构。
如图20所示，缝合线释放组件174包括被致动结构，其中，推动杆177延伸入远侧凹槽对170e中的与其操作地对准的一个相应凹槽或压在该一个相应凹槽上，连杆臂175的纵向轴定向为大体上横向于装载单元116的纵向轴。
参考图15至图20，在制造过程中，在缝合线释放组件174处于未致动结构的情况下，手术用砧座支撑件(未示出)被置于砧座板170的组织接触面170上。接着，手术用缝合线“S1”的第一端被插入到远侧凹槽对170e中的一个凹槽中，而手术用缝合线“S1”的第二端延伸跨过手术用砧座支撑件(未示出)，并插入远侧凹槽对170e中的另一凹槽中。并已考虑到，远侧凹槽对170e中的每一个凹槽都是末端开口式且的收窄式的狭槽，以便将布置于其中的手术用缝合线“S1”以摩擦地方式夹住或系住。
在操作中，在手术用砧座支撑件(未示出)被固定在砧座板170的下表面的情况下，在手术用吻合装置的发射期间，随着驱动组件150被推进(也就是，从最近侧位置移向最远侧位置)，刀片166切穿近侧缝合线(未示出)的中间部分，由此将手术用砧座支撑件(未示出)的近端从砧座组件120上脱离。在使用中，如图20所示，在手术用吻合装置的发射行程接近完成时且驱动组件150接近砧座板170的刀片狭槽170b的最远端时，驱动组件150接触连杆臂175的凸轮面175d，从而推动连杆臂175围绕枢销旋转或枢转，并依次推动推动杆177沿着狭槽的方向平移。随着推动杆177平移，推动杆177开始接触到缝合线“S1”的第二端，并将其推出与该推动杆对准的远侧凹槽170e，从而将缝合线“S1”的第二端从该远侧凹槽170e中释放。在手术用缝合线“S1”的第二端被从远侧凹槽170e中释放或脱离的情况下，手术用砧座支撑件“B1”的远端是自由的以从砧座板170的组织接触面分离。
如图15、图16以及图21至图25所示，装载单元116的钉仓组件118包括钉仓释放组件194，该钉仓释放组件194被支撑在吻合钉钉仓182中，靠近吻合钉钉仓182的远端。释放组件194包括保持器195，该保持器195被支撑在吻合钉钉仓182的远端且位于靠近纵向狭槽182c的远端的位置，并且至少部分地延伸跨过吻合钉钉仓182。保持器195包括主体部195a，凸出部195b从该主体部195a的表面伸出，而且保持器195限定了一形成在其表面中且延伸通过其一侧的通道或凹槽195c。当被支撑在吻合钉钉仓182中时，保持器195的凹槽195c与吻合钉钉仓182的远侧凹槽对182f中一个凹槽相对准。
释放组件194进一步包括推动元件196，该推动元件196具有可枢转地连接到保持器195的凸出部195b上的头部196a。推动元件196进一步包括第一支腿元件196b和第二支腿元件196c，第一支腿元件196b从头部196a延伸而出，第二支腿元件利用活动铰接接头196d连接在第一支腿元件196b的自由端上。推动元件196进一步包括活塞196e，该活塞196e通过活动铰接接头196f连接在第二支腿元件196c的自由端上。活塞196e可滑动地布置在保持器195的凹槽195c中，并能够在该凹槽195c中平移。在一些其他的实施例中，推动器是连杆组件，其具有一端与钉仓可枢转地相连接的第一连杆。第一连杆的另一端可枢转地连接到第二连杆的第一端上。第二连杆的对置的第二端被限制在保持器的凹槽中。
如图24所示，释放组件194包括未致动结构，其中，活塞196e并不延伸入远侧凹槽对182f中的一个相应凹槽或压在该一个相应凹槽上，第一支腿元件196b与第二支腿元件196c彼此成一定的角度，并沿着吻合钉钉仓182的纵向狭槽182c向近侧突出。并已考虑到，缝合线释放组件194可具有摩擦配合或压紧配合特性，以便能够在手术用吻合装置制造/装配之后直到完成发射之前的整个时期内均将缝合线释放组件194维持和/或保持在锁定或锚定结构中。
如图25所示，缝合线释放组件194包括被致动结构，其中，活塞196e延伸入远侧凹槽对182f中的与其操作地对准的一个相应凹槽或压在该一个相应凹槽上，第一支腿元件196b与第二支腿元件196c大体上沿着一共用轴延伸。
参考图21至图25，在制造过程中，在缝合线释放组件194处于未致动结构的情况下，手术用钉仓支撑件(未示出)被置于吻合钉钉仓182的组织接触面上。接着，手术用缝合线“S3”的第一端被插入到远侧凹槽对182f中的一个凹槽中，手术用缝合线“S3”的第二端延伸跨过手术用钉仓支撑件，并插入远侧凹槽对182f中的另一凹槽中。并已考虑到，至少那个与保持器195毗邻的远侧凹槽182f是末端开口式且的收窄式的狭槽，以便将布置于其中的手术用缝合线“S3”以摩擦地方式夹住或系住。
在操作中，在手术用钉仓支撑件(未示出)被固定在吻合钉钉仓182的组织接触面的情况下，在手术用吻合装置10发射期间，随着驱动组件150被推进(也就是，从最近侧位置移向最远侧位置)，刀片166切穿近侧缝合线(未示出)的中间部分，由此将手术用钉仓支撑件的近端从吻合钉钉仓182上脱离。在使用中，如图25所示，在手术用吻合装置10的发射行程接近完成时且驱动组件150接近吻合钉钉仓182的中央纵向狭槽182c的远端时，驱动组件150接触处于第一支腿元件196b与第二支腿元件196c之间的活动铰链连接196d。随着驱动组件150被继续向远侧推进，驱动组件150压向活动铰链连接196d，使得第一支腿元件196b与第二支腿元件196c伸展。随着第一支腿元件196b与第二支腿元件196c伸展，活塞196e平移通过保持器195的凹槽195c。随着活塞196e平移通过保持器195的凹槽195c，活塞196e与缝合线“S3”的第二端接合并将缝合线“S3”推出与该活塞对准的远侧凹槽182f，从而将缝合线“S3”的第二端从该凹槽182f中释放。在手术用缝合线“S3”的第二端被从远侧凹槽182f中释放或脱离的情况下，手术用钉仓支撑件“B”的远端是自由的以从吻合钉钉仓182的组织接触面分离。
现在转向图26至图29，根据本公开另一实施例的用于手术用吻合装置10的装载单元被标识为216。装载单元216与装载单元16或116大体上相似，在此只对两者在构造与操作中需要加以区别的部分进行详细讨论。
如图26至图29所示，装载单元216的砧座组件220包括缝合线释放组件274，该释放组件74布置在砧座板270和盖板272之间，位于与远侧凹槽对270e操作地对准的位置处。释放组件274包括可枢转地连接到砧座板270和/或盖板272上的凸轮275。凸轮275包括具有卵形轮廓的主体部275a，该主体部限定了与远侧凹槽对270e中的一个凹槽操作性关联的凸轮面275b。凸轮275进一步包括从主体部275a的横向边缘成一角度突出的指状部或柄275c。
释放组件274进一步包括可滑动地布置在砧座板270与盖板272之间的推动器277。如图27至图29所示，推动器277可以可滑动地布置在砧座板270a的纵向狭槽270b中。推动器277进一步包括大体上向远侧方向伸出的凸轮臂277a。凸轮臂277a被配置并定尺寸为，与从凸轮275上伸出的指状部275c接合和/或作用于指状部275c上。
如图28所示，缝合线释放组件274包括未致动结构，其中，凸轮275的主体部275a并不延伸入或远侧凹槽对270e中的与其操作地对准的一个相应凹槽或压在该一个相应凹槽上，而推动器277处于回缩的或未推进的位置。如图28所示，推动器277的凸轮臂277a邻近指状部275c，而且可以(虽无必要)与凸轮275的指状部275c相接触。
如图29所示，缝合线释放组件274包括被致动结构，其中，凸轮275的主体部275a延伸入远侧凹槽对270e中的与其操作地对准的一个相应凹槽或压在该一个相应凹槽上，推动器277处于一被推进的位置中。如图29所示，当推动器277处于该推进位置中时，推动器277的凸轮臂277a已经与凸轮275的指状部275c相接合，以使凸轮275的主体部275a旋转。
在操作中，在手术用砧座支撑件(未示出)被固定在砧座板270的下表面上的情况下，在手术用吻合装置发射期间，当驱动组件250接近砧座板270的刀片狭槽270b的最远端时，驱动组件250接触推动器277，由此将推动器277向远侧驱动。当推动器277被向着远侧驱动时，如图28与图29所示，推动器277的凸轮臂277a与凸轮275的指状部275c相接合，以使凸轮275旋转或枢转。当凸轮275旋转时，凸轮275的凸轮面275b开始接触到缝合线“S1”的第二端，并将其推出与该其对准的远侧凹槽270e，从而将缝合线“S1”的第二端从该远侧凹槽270e中释放。在手术用缝合线“S1”的第二端被从远侧凹槽270e中释放或脱离的情况下，手术用砧座支撑件的远端是自由的以从砧座板270的组织接触面分离。
现在转向图30至图31，根据本公开另一实施例的用于手术用吻合装置10的装载单元被标识为316。装载单元316与装载单元16、116或216大体上相似，在此只对两者在构造与操作中需要加以区别的部分进行详细讨论。
如图30与图31所示，装载单元316的砧座组件320包括释放组件374，该释放组件374布置在砧座板370和盖板之间，位于与远侧凹槽对370e操作地对准的位置处。释放组件374包括可滑动地布置在砧座板370a的纵向狭槽370b中的主体部374a。释放组件374进一步包括头部374b，该头部374b连接在主体部374a的远端面或者从主体部374a的远端面延伸出。头部374b沿其侧边限定一凸轮面374c，该凸轮面374c被配置并定尺寸为，用于与形成在砧座板370a中的远侧凹槽对370e中的一个凹槽操作性地关联。凸轮面374c可具有弓形、弧形或正弦曲线状轮廓。
如图30所示，缝合线释放组件374包括未致动结构，其中，主体部374a回缩，凸轮面374c并不延伸入或跨过远侧凹槽对370e中的与其操作地对准的一个相应凹槽中。
如图31所示，缝合线释放组件374包括被致动结构，其中，主体部374a被向远侧推动，凸轮面374c延伸入远侧凹槽对370e中的与其操作地对准的一个相应凹槽或压在该一个相应凹槽上。
在操作中，在手术用砧座支撑件(未示出)被固定在砧座板370的下表面上的情况下，在手术用吻合装置发射期间，当驱动组件350接近砧座板370的刀片狭槽370b的最远端时，如图30与图31所示，驱动组件350接触释放组件374的主体部374a，由此将头部374b向远侧驱动。当头部374b被向远侧驱动时，凸轮面374c开始接触到缝合线“S1”的第二端，并将其推出与该其对准的远侧凹槽370e，从而将缝合线“S1”的第二端从该远侧凹槽370e中释放。在手术用缝合线“S10”的第二端被从远侧凹槽370e中释放或脱离的情况下，手术用砧座支撑件的远端是自由地以砧座板370的组织接触面分离。
在另一实施例中，驱动头部可以包括锋利的边缘以代替凸轮面374c。随着驱动头部被移向远侧，缝合线“S1”被卡在驱动头部的锋利边缘与远侧凹槽370e的侧边之间，从而切割缝合线“S1”。
现在转向图32至图38，根据本公开另一实施例的用于手术用吻合装置10的装载单元被标识为416。装载单元416与装载单元16、116、216或316大体上相似，在此只对两者在构造与操作中需要加以区别的部分进行详细讨论。
如图32至图38所示，装载单元416的钉仓组件418包括钉仓释放组件494，该钉仓释放组件494被支撑在吻合钉钉仓482中，靠近吻合钉钉仓482的远端。释放组件494包括保持器495，该保持器195被支撑在吻合钉钉仓482远端，位于靠近纵向狭槽482c的远端的位置，并且至少部分地延伸跨过吻合钉钉仓482。保持器495包括主体部495a，凸出部495b从该主体部495a的表面伸出，并且保持器495限定了一形成在其表面中且延伸通过其一侧的通道或凹槽495c。保持器495的主体部495a限定狭槽495d，狭槽495d形成在主体部的对置的侧边中，并被配置为将缝合线容纳于其中。当支撑在吻合钉钉仓482中时，保持器495的凹槽495c与吻合钉钉仓482的远侧凹槽对482f中一个凹槽相对准，保持器495的狭槽495d与吻合钉钉仓482的远侧凹槽对482f相对准(参见图32)。
释放组件494进一步包括凸轮元件496，该凸轮元件496具有可枢转地连接到保持器495的凸出部495b上的头部496a。凸轮元件496进一步包括从头部496a伸出的主体部496b。主体部496b限定了第一凸轮面496c与第二凸轮面496d，每一凸轮面均大体上以与凸轮元件496的旋转轴相切的方式伸出。
释放组件494进一步包括可滑动地布置于保持器495的通道495c中的滑块497。滑块497包括主体部497a，主体部497a限定了一凸轮面497b与一侧壁497c，凸轮面497b被定向为与凸轮元件496的第二凸轮面496d操作地接合，侧壁497c与吻合钉钉仓482的远侧凹槽对482f中的与保持器495的凹槽495c对准的那个凹槽对准。
如图37所示，释放组件494包括未致动结构，其中，凸轮元件496的第一凸轮面496c延伸跨过吻合钉钉仓482的纵向狭槽482c，滑块497的侧壁497c并不延伸入吻合钉钉仓482的远侧凹槽对482f中的与其操作地对准的那一个凹槽或延伸压在那一个凹槽上，凸轮元件496的第二凸轮面496d与滑块497的凸轮面497b基本上齐平的接触。
如图38所示，释放组件494包括被致动结构，其中，凸轮元件496的第一凸轮面496c并未充分延伸跨过吻合钉钉仓482的纵向狭槽482c，而滑块497的侧壁497c延伸入吻合钉钉仓482的远侧凹槽对482f中的与其操作地对准的那一个凹槽或延伸压在那一个凹槽上，并且凸轮元件496的第二凸轮面496d与滑块497的凸轮面497b分开。
参考图32至图38，在制造过程中，在缝合线释放组件494处于未致动结构的情况下，手术用钉仓支撑件(未示出)被置于吻合钉钉仓482的组织接触面上。接着，手术用缝合线“S3”的第一端被插入到远侧凹槽对482f中的一个凹槽中，手术用缝合线“S3”的第二端延伸跨过手术用钉仓支撑件，并插入远侧凹槽对482f中的另一凹槽中。并已考虑到，至少那个与侧壁497c毗邻的远侧凹槽对482f是开端的收缩型狭槽，以便将布置于其中的手术用缝合线“S3”以摩擦地方式夹住或系住。
在操作中，在手术用钉仓支撑件(未示出)被固定在吻合钉钉仓482的组织接触面上的情况下，在手术用吻合装置发射期间，当驱动组件450接近吻合钉钉仓482的中央纵向狭槽482c的远端时，如图38所示，驱动组件450接触凸轮元件496的第二凸轮面496c，第二凸轮面496c延伸跨过吻合钉钉仓482的纵向狭槽482c。
当驱动组件450被继续向远侧推进时，驱动组件450压向凸轮元件496的第一凸轮面496c，从而促使凸轮元件496旋转。当凸轮元件496被转动时，其第二凸轮面496d接触到并压向滑块497的凸轮面497b，因而使滑块497平移进保持器495的凹槽495c中。当滑块497平移通过凹槽495c时，滑块497的侧壁497c与缝合线“S3”的第二端接合并将缝合线“S3”推出与该侧壁497c对准的远侧凹槽482f，从而将缝合线“S3”的第二端从该凹槽182f中释放。在手术用缝合线“S3”的第二端被从远侧凹槽482f中释放或脱离的情况下，手术用钉仓支撑件的远端是自由的以从吻合钉钉仓482的组织接触面分离。
根据本公开的另一实施例，已经考虑到，支撑件“B”可设置有或形成有一体的翼片或突出部，该翼片或突出部从支撑件上伸出，用于插入和/或容纳进砧座组件和/或钉仓组件的远侧凹槽和/或近侧凹槽中。进一步地，已经考虑到，缝合线“S”可被粘贴、嵌入或其他方式连接到支撑件“B”。
在共同转让的专利号为5,542,594；5,908,427；5,964,774；和6,045,560的美国专利；以及在2006年4月20日提交的共有地转让的序列号为2006/0085034的美国专利申请；以及于2006年6月22日提交的序列号为2006/0135992的美国专利申请中，对公开于此的与手术用缝合设备联合使用的典型手术用支撑件“B”进行了展示与说明，上述专利与专利申请的全部内容通过引用合并与此。
手术用支撑件“B”可由适合的生物相容性和生物可吸收性材料制成。手术用支撑件“B”可由不存留液体的无吸收性材料制成。手术用支撑件“B”可由“BIOSYN”制成，其中“BIOSYN”是由GLYCOMER 631(一种嵌段共聚物)制备的，而GLYCOMER 631是一种由乙交酯、二噁烷酮(dioxanone)和亚丙基二碳酸酯(trimethylene carbonate)组成的合成聚酯。
所得共聚物的一嵌段包含衍生自对二噁烷酮(1，4-二噁烷-2-酮)和亚丙基二碳酸酯(1，3-二噁烷-2-酮)的随机组合单元。共聚物的第二嵌段包含衍生自乙交酯和对二噁烷酮的无规组合单元。所得聚酯是一种ABA型三嵌段三元共聚物，其带有约60％的乙交酯、约14％的二噁烷酮和约26％的亚丙基二碳酸酯。
应该理解的是，可对公开于此的实施例作各种修改。例如，缝合装置不需施加吻合钉，而是可以施加现有技术中公知的两部件式紧固件。另外，可对吻合钉或紧固件的线形排的长度作修改，以便符合特殊手术程序的要求。因此，致动轴的单个行程长度和/或一次性装载单元中的吻合钉或紧固件的线形排的长度可以相应地变化。因此，上述说明不应被理解为是对本发明的限制，而只能被理解为各种优选实施例的范例。本领域的技术人员在本发明权利要求的范围或精神之内可以设计其它修改方案。

Claims (15)

1.一种手术用吻合装置，其包括：
壳体；
手柄，其由所述壳体支撑；
细长体，其从所述壳体向远侧延伸；
工具组件，其位于所述细长体的远端，所述工具组件具有一个钉仓组件和一个砧座组件，所述钉仓组件包括一个其中具有多个手术用紧固件的吻合钉钉仓，钉仓组件和砧座组件中的至少一个相对于钉仓组件和砧座组件中的另一个是可移动的；
手术用支撑件，其利用锚定件可释放地固定在砧座板和吻合钉钉仓中的至少一个的组织接触面上，砧座组件和钉仓组件中的至少一个包括收窄式的且末端开口式的狭槽，所述狭槽被配置为夹住所述锚定件的端部；
释放组件，其与砧座组件和钉仓组件中的所述至少一个相关联；以及
驱动组件，其能够从近侧位置到远侧位置可滑动地平移通过所述工具组件，所述驱动组件致动所述释放组件，从而将所述锚定件的端部推出所述狭槽且使所述手术用支撑件脱离砧座组件和钉仓组件中的所述至少一个。
2.根据权利要求1所述的手术用吻合装置，其中，砧座组件和钉仓组件中的所述至少一个限定了用于将所述至少一个锚定件的端部容纳于其中的侧向狭槽。
3.根据权利要求1所述的手术用吻合装置，其中，所述释放组件具有第一杆和第二杆，所述驱动组件致动所述第一杆，所述第一杆将所述第二杆移入所述狭槽中。
4.根据权利要求1所述的手术用吻合装置，其中，所述砧座组件和钉仓组件中的每一个均包括释放组件。
5.根据权利要求4所述的手术用吻合装置，其中，所述砧座组件和钉仓组件中的每一个均限定了用于容纳每一手术用支撑件的锚定件的侧向狭槽。
6.根据权利要求1所述的手术用吻合装置，其中，所述释放组件包括与所述狭槽可操作地关联的推动器，所述推动器是可被致动的从而将所述锚定件的端部推出所述狭槽。
7.根据权利要求6所述的手术用吻合装置，其中，所述驱动组件包括一向远侧推进的驱动构件，所述释放组件能够被该驱动构件致动。
8.根据权利要求7所述的手术用吻合装置，其中，所述吻合钉钉仓与砧座组件包括纵向延伸狭槽，所述驱动构件前进穿过所述钉仓组件与所述砧座组件，并穿过所述纵向延伸狭槽。
9.根据权利要求6所述的手术用吻合装置，其中，所述释放组件的推动器被可枢转地连接到砧座组件和钉仓组件中的所述至少一个上。
10.根据权利要求6所述的手术用吻合装置，其中，所述释放组件的推动器被可滑动地支撑在砧座组件和钉仓组件中的所述至少一个上。
11.根据权利要求1所述的手术用吻合装置，其中，所述锚定件是与所述手术用支撑件及钉仓组件和砧座组件中的所述至少一个相接合的缝合线。
12.根据权利要求1所述的手术用吻合装置，其中，所述锚定件是所述手术用支撑件的延伸部，并且与钉仓组件和砧座组件中的所述至少一个相接合。
13.根据权利要求6所述的手术用吻合装置，其中，所述推动器被可枢转地安装在钉仓组件和砧座组件中的所述至少一个中。
14.根据权利要求13所述的手术用吻合装置，其中，所述推动器包括可枢转地连接到第二支腿元件上的第一支腿元件。
15.根据权利要求13所述的手术用吻合装置，其中，所述推动器具有活塞，所述活塞被可滑动地安装在钉仓组件和砧座组件中的所述至少一个中的细长凹槽中。
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