CN104546057A - 外科施夹器 - Google Patents

外科施夹器 Download PDF

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CN104546057A
CN104546057A CN201410770937.7A CN201410770937A CN104546057A CN 104546057 A CN104546057 A CN 104546057A CN 201410770937 A CN201410770937 A CN 201410770937A CN 104546057 A CN104546057 A CN 104546057A
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clip
follower
surgical
handle
surgical clip
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CN104546057B (zh
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厄尔·M·策吉贝尔
拉米罗·卡布雷拉
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Covidien 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
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/90—Identification means for patients or instruments, e.g. tags
    • A61B90/92—Identification means for patients or instruments, e.g. tags coded with colour
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00115—Electrical control of surgical instruments with audible or visual output
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00407—Ratchet means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B2017/12004—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for haemostasis, for prevention of bleeding
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/038—Automatic limiting or abutting means, e.g. for safety during shipment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0803—Counting the number of times an instrument is used
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0814—Preventing re-use

Abstract

本发明提供了一种外科施夹器，所述外科施夹器包括：外壳；至少一个手柄，其可移动地连接到所述外壳上；通道组件，其从所述外壳向远侧延伸出；夹子承载器，其布置在所述通道组件内且在其中限定了通道，所述夹子承载器的所述通道构造为在其中可滑动地容纳多个夹子；楔形板，其布置在所述通道组件内；夹子推杆，其布置在所述外壳和所述通道组件内；以及夹子输出器，其可滑动地布置在所述夹子承载器的通道内并且布置在所述多个夹子的近侧。所述夹子输出器被构造为在所述多个夹子中的最后一个夹子已经被所述外科施夹器排出之后锁定所述外科施夹器。

Description

外科施夹器
本申请为申请日为2011年2月21日，申请号为201110044109.1，发明名称为外科施夹器的中国专利申请的分案申请。
技术领域
本申请涉及外科器械，更特别地，涉及具有多个夹子的外科施夹器，所述外科施夹器用于在外科手术操作中将夹子施加到身体组织和血管上。
背景技术
外科施夹器是本领域中已知的，并由于为身体组织和血管的传统缝合提供了一种选择而得到更多外科医生的欢迎。在格林(Green)等人的专利号为5,030,226的美国专利和伯班克三世(Burbank III)等人的专利号为5,431,668的美国专利中公开了典型的器械。这些器械通常提供多个夹子，所述多个夹子被存储在器械中并在器械近端处手柄的开合时被相继送入器械远端处的钳夹机构。当手柄闭合时，钳夹闭合以使位于钳夹构件之间的夹子变形，而当钳夹张开以释放变形的夹子时，一个新的夹子从其序列被送入钳夹之间的位置。这个过程被重复执行直到夹子序列中的所有夹子都已得到应用。
典型地，在最后一个夹子已经被施加到身体组织上之后从手术部位移除外科施夹器。之后，外科施夹器由替换的外科施夹器替代或现有的外科施夹器被再装满替换的手术夹子。然而，在特定场合下，当在施加了最后一个夹子之后同一外科施夹器被错误地使用时，外科施夹器的钳夹构件可能在手术部位不必要地抓紧身体组织。结果，身体组织可能被损坏，这有时会对患者造成创伤。
因此，存在对构造为在已经施加了最后一个夹子之后锁定手柄的外科施夹器的需求。
发明内容
本公开涉及具有多个夹子的外科施夹器，所述外科施夹器用于在外科手术操作期间将所述夹子施加到身体组织和血管上。
根据本公开的方案，提供了一种外科施夹器，其包括：外壳；至少一个手柄，其可枢转地连接到外壳上；通道组件，其从外壳向远侧延伸出；夹子承载器(clip carrier)，其布置在通道组件内且在其中限定了通道和多个窗口；多个夹子，它们可滑动地布置在夹子承载器的通道内；楔形板，其可往复运动地布置在通道组件内；以及夹子推杆，其可往复运动地设置在外壳和通道组件内。推杆具有可操作地连接到至少一个手柄上的近端和限定了推动器的远端。推杆的远端被构造为与多个夹子中的最远侧夹子接合。夹子输出器(clipfollower)可滑动地布置在夹子承载器的通道内并且布置在多个夹子的近侧。夹子输出器被构造且定尺寸为在多个夹子中的最后一个夹子被外科施夹器排出之后锁定施夹器。
施夹器可进一步包括钳夹组件，该钳夹组件包括从通道组件的与外壳相反的一端延伸出的一对钳夹。钳夹组件适于在其中容纳夹子并且能够响应于至少一个手柄的运动进行操作以实现夹子的成型。推杆可以随着至少一个手柄在第一方向上接近而朝向钳夹运动以便移动所述钳夹之间的最远侧夹子。推杆可以被构造且适于随着至少一个手柄在第一方向上进一步接近而朝向外壳运动以便移动在多个夹子中的最远侧夹子之后的推动器。
在实施例中，夹子输出器可包括在其主体部中形成的窗口。在至少一个手柄被进一步致动时，推动器末端的远端布置在夹子输出器的窗口中。夹子输出器可以布置在夹子通道的远端内并且夹子承载器的至少一个弹性柄脚的下压力有助于将夹子输出器保持在夹子通道的远端。
在实施例中，在至少一个手柄被进一步致动时，夹子推动器接合夹子输出器的窗口的远端并且向远侧推进夹子输出器从而在钳夹之间运动。钳夹朝向彼此接近并且夹子输出器在钳夹之间被推进从而防止钳夹闭合。在至少一个手柄被进一步致动时，棘轮机构被部分地接合从而将至少一个手柄锁定在适当的位置上。
夹子输出器可被构造为在已经排出多个夹子中的最后一个夹子之后锁定至少一个手柄。在至少一个手柄从致动位置被释放时，推杆返回到近侧位置，并且基本是在同时，夹子输出器在夹子承载器内向远侧前进。在至少一个手柄从致动位置被释放时，所述夹子推动器向近侧缩回到近侧位置。
在实施例中，夹子输出器可沿其每一侧限定至少一个凹口。至少一个凹口被构造为有助于使夹子输出器在横向于由其主体部限定的平面的方向上弯曲。夹子输出器还可被构造为且适于与夹子承载器的窗口和楔形板的孔选择性接合。夹子输出器可被构造为且适于在楔形板往复运动时在相对于夹子承载器的远侧方向上推进多个夹子。夹子输出器可以通过楔形板的前后往复运动来致动。
附图说明
由于本发明的施夹器通过下述结合下列附图考虑时的详细描述而变得更好理解，因此将能够更充分地认识本发明的施夹器。在附图中：
图1为根据本公开的实施例的外科施夹器的立体图；
图2为图1的外科施夹器的后视立体图，示出了装运楔在适当的位置处；
图3为图1至图2的外科施夹器的分解立体图；
图4为图1至图3的外科施夹器的夹子输出器的顶视立体图；
图5为图1至图3的外科施夹器的纵向剖视图，图示了外科施夹器处于未致动状态；
图6为图5所指示细节区域的放大图；
图7为图5所指示细节区域的放大图；
图8为图5所指示细节区域的放大图；
图9为图1至图3的外科施夹器的通道组件的远端的顶视立体图，从其移除了盖；
图10为图9的通道组件的远端的顶视立体图，从其移除了盖和推杆；
图11为图9的通道组件的远端的顶视立体图，从其移除了盖、推杆和夹子承载器；
图12为图9的通道组件的远端的顶视立体图，从其移除了盖、推杆、夹子承载器、外科夹子和夹子输出器；
图13为图12所指示细节区域的放大图；
图14为图1至图3的外科施夹器的顶视立体图，图示了从其移除了上半外壳、推杆和楔形板；
图15为图9的通道组件的远端的顶视立体图，从其移除了盖、推杆、夹子承载器、外科夹子、夹子输出器和楔形板；
图16为示出图1至图3的外科施夹器在从其发射出最后一个外科夹子之后的锁定状态下的通道组件的远端的纵向剖视图；
图17为根据本公开的与图1至图16的外科施夹器一起使用的夹子输出器的另一个实施例的顶视立体图；
图18为图1至图16的外科施夹器的通道组件的远端的顶视立体图，图示了一对保持用柄脚保持最后一个手术夹子；
图19为图1至图16的外科施夹器的通道组件的远端的顶视立体图，图示了图17的夹子输出器处于通道组件中的远侧位置；
图20为图1至图16的外科施夹器的通道组件的远端的顶视立体图，图示了夹子输出器在一对钳夹构件之间布置和/或前进；
图21为图1至图16的外科施夹器的通道组件的远端的顶视立体图，图示了推杆在近侧方向上缩回；以及
图22为根据本公开的另一个实施例的图18的夹子输出器的顶视立体图。
具体实施方式
现在将参照附图对依照本公开的外科施夹器的实施例进行详细描述，其中相同的附图标记代表类似或相同的结构元件。如附图所示以及如下贯穿说明书所描述的，当涉及外科器械的相对定位时，跟传统的一样，术语“近侧”表示装置的较靠近用户的一端，而术语“远侧”表示装置的较远离用户的一端。
图1至图5图示的依照本公开的实施例的外科施夹器通常用100表示。可以参考下述申请：于2008年8月25日提交的、申请号为61/091,467、名称为“Surgical Clip Applier(外科施夹器)”的美国临时申请和于2008年8月25日提交的、申请号为61/091,485、名称为“Surgical Clip Applier and Methodof Assembly(外科施夹器及其装配方法)”的美国临时申请，将所述每个申请的全部内容通过引用都并入于此，用于详细讨论外科施夹器100的结构、操作和装配方法。
简言之，外科施夹器100为包括手柄组件102的外科器械，所述手柄组件102包括具有上半外壳104a和下半外壳104b的外壳104。手柄组件102进一步包括一对手柄106，所述一对手柄106可枢转地固定在外壳104上并从外壳104向外延伸出。通道组件108稳固地固定在外壳104上并从外壳104向外延伸出，终止于钳夹组件110。
如在图1至图3中可见，施夹器100的半外壳104a和104b彼此通过卡扣配合(snap fit)接合而装在一起。外壳104限定了形成于下半外壳104b中的用于支撑和显示计数器机构190的窗口104c。外壳104由合适的塑性材料制成。
如在图3中可见，手柄106通过手柄枢转支柱104d固定在外壳104上，所述手柄枢转支柱104d从下半外壳104b延伸出并进入到形成于手柄106中的相应的孔106a中。手柄组件102包括连杆构件122，所述连杆构件122在形成于相应手柄106中的枢轴点106b处可枢转地连接至每个手柄106。每个连杆构件122的远端122a通过驱动销124可枢转地连接到形成于驱动通道140中的枢轴点140a。驱动销124的每端被可滑动地容纳在形成于相应的上、下半外壳104a、104b中的细长通道104e中。使用时，当挤压手柄106时，连杆构件122通过驱动销124向远侧推动驱动通道140。
通道组件108包括通道或筒形盖(cartridge cover)130和外部或下部通道132，所述通道或筒形盖130和外部或下部通道132各自均具有保持在外壳组件102中并位于上、下半外壳104a、104b之间的近端。筒形盖130包括至少一个保持元件130a，所述至少一个保持元件130a被构造为且适于选择性地以卡扣配合接合的方式接合设置在外部通道132上的互补或相应的保持元件132a。
如在图3和图6至图9中可见，施夹器100包括可滑动地布置在筒形盖130下方的夹子推杆160。推杆160包括限定了推动器160c的远端160a，所述推动器160c被构造为且适于选择性地接合/移动存储在外科施夹器100中的最远侧夹子“C1”。推杆160进一步包括近端160b，所述近端160b在其中限定了近侧窗口160d，所述近侧窗口106d用于可滑动地容纳驱动销124于其中。推杆160进一步在其中限定了用于可操作地与稳定器162接合的远侧窗口160e。推杆160还包括翼片(fin)160f，所述翼片160f从推杆160的侧边缘突出并且位于近侧窗口160d的相对近侧。
施夹器100进一步包括稳定器162，所述稳定器162被构造为覆于推杆160之上并与其接合。稳定器162包括：远侧突起162a，其被构造为接合推杆160的远侧窗口160e；细长窗口162b，在其中限定为位于基本覆于形成于推杆160中的近侧窗口160d之上并与近侧窗口160d对准的位置处。更多关于稳定器162的详细讨论，请参见共有的于2008年8月25日提交的、申请号为61/091,467、名称为“Surgical Clip Applier(外科施夹器)”的美国临时申请和于2008年8月25日提交的、申请号为61/091,485、名称为“SurgicalClip Applier and Method of Assembly(外科施夹器及其装配方法)”的美国临时申请，将所述每个申请的全部内容通过引用都并入于此。
如在图3中可见，施夹器100进一步包括运动倍增系统(motion multipliersystem)，所述运动倍增系统具有被可枢转地支撑在外壳104中的双臂曲柄齿轮(bell crank gear)154以及可滑动地支撑在外壳104中的加速器外壳156。关于双臂曲柄齿轮154的更详细的讨论，请参见共有的于2008年8月25日提交的、申请号为61/091,467、名称为“Surgical Clip Applier(外科施夹器)”的美国临时申请和于2008年8月25日提交的、申请号为61/091,485、名称为“Surgical Clip Applier and Method of Assembly(外科施夹器及其装配方法)”的美国临时申请，将所述每个申请的全部内容通过引用都并入于此。
继续参考图3，运动倍增系统的加速齿条156包括基壁156a，所述基壁156a限定了形成于其中的细长的纵向延伸的槽156b，用于可滑动地容纳双臂曲柄齿轮154的枢轴销154a。加速齿条156包括从基壁156a的侧边缘沿相反方向突出的侧壁156c，以及形成在侧壁156c中并且与基壁156a的槽156b校准或对准的齿条156d。齿条156d被构造为与双臂曲柄齿轮154的正齿轮154d的齿轮齿154g啮合。
施夹器100进一步包括偏置构件158，所述偏置构件158使加速齿条156和驱动通道140相互连接。
施夹器100进一步包括布置在通道组件108内且位于推杆160下方的夹子承载器170。夹子承载器170通常呈盒状结构，具有上壁170a、一对侧壁170b和下壁170c，从而限定了穿过其中的通道170d。夹子承载器170包括多个间隔开的窗口172，所述窗口172形成于上壁170a中并沿其长度纵向延伸。夹子承载器170包括形成于下壁170c中并沿其长度纵向延伸的细长窗口170e。
如在图3和图10中可见，一叠外科夹子“C”以如下方式被装载和/或保持在夹子承载器170的通道170d内：使得一叠外科夹子“C”在所述通道170d内滑动和/或沿通道170d滑动。通道170d被构造且定尺寸为将一叠或多个外科夹子“C”以头尾相接的方式可滑动地保持于其内。
如在图3、图9和图10中可见，夹子承载器170的远端包括一对间隔开的弹性柄脚171。柄脚171被构造为且适于选择性地接合保持在夹子承载器170内的一叠外科夹子“C”的最远侧外科夹子“C1”的后跨部。
如在图3、图4、图7和图11中可见，施夹器100进一步包括可滑动地布置在夹子承载器170的通道170d内的夹子输出器174。如下文将要更详细地讨论的，夹子输出器174位于这叠外科夹子“C”的后方，并且设置为在施夹器100的致动期间将这叠夹子“C”向前推进。如下文将要更详细地讨论的，通过楔形板180的前后往复运动来致动夹子输出器174。
如在图4和图7中可见，夹子输出器174包括：限定了一平面的主体部174a，从主体部174a基本上向上和向后延伸出的远侧突起175，以及从主体部174a基本上向下和向后延伸出的近侧突起176。远侧突起175包括：在由主体部174a限定的所述平面下方向下延伸的远侧部175a；和在由主体部174a限定的所述平面上方向上延伸的近侧部175b。
远侧突起175的近侧部175b被构造且定尺寸为选择性地接合形成于夹子承载器170的上壁170a中的窗口172。使用时，夹子输出器174的远侧突起175的近侧部175b接合在形成于夹子承载器170的上壁170a中的窗口172中，防止夹子输出器在近侧方向上平移或运动。
近侧突起176被构造且定尺寸为选择性地接合形成于楔形板180中的窗口180b。使用时，夹子输出器174的近侧突起176接合在形成于楔形板180中的窗口180b中，使得夹子输出器174基于楔形板180的远侧运动而向远侧前进或运动。
如在图3、图7、图8、图12和图13中可见，施夹器100进一步包括可滑动地布置在手柄组件102和通道组件108内的楔形板180。楔形板180定位或布置在夹子承载器170的下方。楔形板180包括用于选择性可操作地插在钳夹120之间的基本锥形的远端180a。楔形板180限定了：沿其长度纵向延伸并形成于其隆起部分中的间隔开的多个窗口或孔180b、位于孔180b远侧的远侧窗口或孔180c，以及定位在孔180c近侧的最近侧横向定向槽180d。
如在图3、图8、图12和图13中可见，施夹器100包括由筒形盖130支撑的远侧锁定件178。远侧锁定件178包括尾部或突起178a，所述尾部或突起178a基本上向后和向下延伸并构造且定尺寸为被容纳在楔形板180的远侧窗口或孔180c中。
如在图3、图6和图14中可见，施夹器100包括楔形板运动反向机构，所述楔形板运动反向机构呈枢转臂179的形式，被可枢转地支撑在外壳104的下半外壳104b中，用于将驱动通道140的平移传递成楔形板180的反向平移。
使用时，当驱动通道140向远侧运动时，在一停顿时间段(即，驱动通道140的槽140g的纵向延伸的远侧部的长度)之后，第二柱杆或指状部179c在远侧方向上运动，使枢转臂179旋转，从而使第一柱杆或指状部179b在第二方向上运动。当第一柱杆或指状部179b在第二方向上运动时，第一柱杆或指状部179b将楔形板180从钳夹120之间拉出，推进或向近侧推动推动器160的翼片160f以使推动器160在近侧方向上运动，从而使其推杆160c从钳夹120之间移除，反之亦然。当楔形板180在远侧方向上运动时，如在图13中可见，楔形板180的远端180a抵靠钳夹120的内表面做凸轮运动，从而保持钳夹120彼此间隔开。
如在图3、图6至图8、图14和图15中可见，施夹器100包括驱动通道140，所述驱动通道140被可往复运动地支撑在手柄组件102的外壳104和通道组件108中并在二者之间延伸。驱动通道140的近端被支撑在外壳104的上、下半外壳104a、104b之间，而驱动通道140的远端被支撑在通道组件108的筒形盖130和外部通道132之间，位于楔形板180下方的一位置处。
驱动通道140的远端是基本呈U形的通道，其包括在远离外部通道132且朝向筒形盖130的方向上、从其后跨部140c延伸出的一对间隔开的侧壁140b。驱动通道140进一步限定了形成于后跨部140c中、用于可枢转地容纳驱动销124穿过其中的驱动销凹槽140a。驱动通道140进一步限定了位于驱动销凹槽140a远侧的位置处、从后跨部140c突出的肋状物140e。驱动通道140进一步限定了形成于后跨部140c中、位于槽140e远侧的位置处的往复运动限制槽140f。
如在图3、图8至图12和图15中可见，施夹器100包括固定到驱动通道140上的驱动通道带箍143。带箍143固定到驱动通道140的直立部140b上，以便横跨直立部140b延伸。带箍143在位于往复运动限制槽140f的远侧的位置固定到驱动通道140上。带箍143固定到驱动通道140上以使楔形板180在带箍143下方和钳夹120上方延伸。
如在图3和图6中可见，施夹器100进一步包括通过驱动销124连接到驱动通道140的听觉/触觉指示器148。指示器148包括弹性指状部148a和一对凸起部148b。使用时，当将施夹器100致动并使驱动通道140往复运动时，指示器148的第一弹性指状部148a与设置在施夹器100中的相应的互补结构或凸耳(ledge)149相互作用，以给用户生成听觉和/或触觉反馈。指示器148的凸起部148b搭在形成于上半外壳104a的通道104e中并向指示器148提供支撑以防止指示器148旋转。
如在图3、图6和图14中可见，施夹器100进一步包括偏置构件146，所述偏置构件146呈拉力弹簧的形式，可操作地固定到驱动通道140的近端和外壳104上并处于二者之间，趋向于保持驱动通道140处于缩回或最近侧的位置。偏置构件146的作用在于在位于钳夹120之间的夹子“C”成型之后使驱动通道140缩回或便于驱动通道140缩回。
如在图3和图14中可见，驱动通道140的近端包括齿条构件141，所述齿条构件141固定在驱动销124上并可与驱动通道140一起运动。齿条构件141被构造为且适于与支撑在外壳104中的棘爪142接合。齿条构件141和棘爪142限定了棘轮机构144。使用时，当驱动通道140轴向运动时，齿条构件141也运动。齿条构件141限定了一系列具有一定长度的齿条齿141a，随着驱动通道140到达最近侧或最远侧位置，当齿条构件141在近侧运动和远侧运动之间变化时，所述长度允许棘爪142反向并在齿条构件141上返回。
在棘爪142基本上与齿条构件141可操作地接合的位置处，通过棘爪销147将棘爪142可枢转地连接到下半外壳104b上。棘爪142能够与齿条构件141接合以限制齿条构件141的纵向运动，并且依次限制驱动通道140的纵向运动。棘轮机构144进一步包括爪簧145，所述爪簧145被构造且定位为将棘爪142偏置至与齿条构件141可操作地接合。爪簧145的作用在于保持棘爪142的齿与齿条构件141的齿141a啮合，以及保持棘爪142处于旋转或倾斜的位置。
如在图1至图3、图8至图13和图15中可见，施夹器100包括安装在通道组件108的远端上或远端处的一对钳夹120，所述钳夹120能够通过手柄组件102的手柄106来致动。钳夹120由例如不锈钢或钛的适合的生物相容性材料制成。
通过延伸穿过驱动通道140的往复运动限制槽140f的铆钉122或类似物将钳夹120安装在驱动通道140的远端中，以使得钳夹120相对于外部通道132和驱动通道140是纵向固定的。如在图9、图10、图13和图15中可见，钳夹120在其间限定了用于容纳外科夹子“C1”于其中的通道120a。
如在图1至图3和图6中可见，施夹器100进一步包括支撑在手柄组件102的外壳104中的计数器机构190。计数器机构190包括显示器192、处理器194和电池等形式的能源198。显示器192为向外科医生显示施夹器100的一个或多个操作参数的液晶显示器。所显示的操作参数可为剩余夹子的数量或数目、已经使用过的夹子的数目、位置参数、使用的手术时间，或者该过程的任何其它参数。关于计数器机构190的更详细的讨论，请参见共有的于2008年8月25日提交的、申请号为61/091,467、名称为“Surgical Clip Applier(外科施夹器)”的美国临时申请和于2008年8月25日提交的、申请号为61/091,485、名称为“Surgical Clip Applier and Method of Assembly(外科施夹器及其装配方法)”的美国临时申请，将所述每个申请的全部内容通过引用都并入于此。
如在图2中可见，施夹器100包括支撑在外壳104上并插在手柄106之间的装运楔200。装运楔200的作用在于：在装运和/或存储施夹器100时保持手柄106间隔开或不被挤压。装运楔200连接到计数器机构190的翼片192a上，以使得终端用户使用施夹器100时，终端用户必须移除装运楔200，从而也移除翼片192a来启动计数器机构190。关于装运楔200的更详细的讨论，请参见共有的于2008年8月25日提交的、申请号为61/091,467、名称为“Surgical Clip Applier(外科施夹器)”的美国临时申请和于2008年8月25日提交的、申请号为61/091,485、名称为“Surgical Clip Applier and Method ofAssembly(外科施夹器及其装配方法)”的美国临时申请，将所述每个申请的全部内容通过引用都并入于此。
现在转到图16，图示了在手柄106的完整行程或挤压之后且在从其排出最后一个夹子之后的施夹器100的远端。在发射出最后一个夹子之后，如在图16中可见，夹子输出器的近侧突起176布置在楔形板180的孔180b的最远侧孔或窗口内。如此，当在发射出夹子之后楔形板180向远侧运动时，以上述方式，夹子输出器174也向远侧运动。因此，当夹子输出器174向远侧运动时，其远侧突起175运动到夹子承载器170的窗口172的最远侧窗口的远侧。如此，远侧突起175的近侧部175b紧密接合夹子承载器170的顶壁的内表面并向下做凸轮运动或推进。
当远侧突起175的近侧部175b向下做凸轮运动或推进时，远侧突起175的远侧部175a紧密接合锁定件178的突起178a的上表面，并且使锁定件178的突起178a向下做凸轮运动或推进而横跨带箍143的路径被支撑在驱动通道140上且进入到楔形板180的远侧窗口180c中。如此，如果驱动通道140向远侧前进，以上述方式，带箍143将紧靠锁定件178的突起178a并且防止或阻碍带箍143并且依次防止或阻碍驱动通道140向远侧运动。此时，棘爪142位于在齿条140d的远侧的停顿处，并且手柄106布置在完全张开位置，因此不能被再进一步地张开。在这种构造中，施夹器被锁定且不能再被使用。
现在参考图17至图22，依照本公开的实施例的外科施夹器通常用300表示。外科施夹器300与外科施夹器100基本相同，因此在此将只在识别其结构和操作的区别所必要的程度上详细说明。
如图18至图21所示，施夹器300包括可滑动地布置在夹子承载器370的通道370d内的夹子输出器374。夹子输出器374位于一叠外科夹子“C”的后方并且设置为在外科施夹器300的致动过程中向前推进一叠夹子“C”，以与上述夹子输出器174相似的方式。如图3、图5、图6和图8至图10所示并且参考夹子输出器174，通过楔形板(未示出)的前后往复运动来致动夹子输出器374。在所述实施例中，如将在下文所说明的，夹子输出器374还被构造为在最后一个夹子“CL”已被排出之后锁定施夹器300。
如在图17和图22中可见，夹子输出器374包括：限定了一平面的主体部374a，从主体部374a基本上向上和向后延伸出的远侧突起375，从主体部374a基本上向下和向后延伸出的近侧突起376，以及形成在主体部374a的远侧部374b上的槽或窗口377。远侧突起375包括：在由主体部374a限定的所述平面下方向下延伸的远侧部375a；和在由主体部374a限定的所述平面上方向上延伸的近侧部375b。
远侧突起375的近侧部375b被构造且定尺寸为选择性地接合形成于夹子承载器370的上壁中的窗口，如上述关于夹子承载器170的讨论。使用时，夹子输出器374的远侧突起375的近侧部375b接合在形成于夹子承载器370的上壁中的窗口中，防止夹子输出器在近侧方向上平移或运动。
近侧突起376被构造且定尺寸为选择性地接合形成于楔形板(未示出)中的窗口。使用时，夹子输出器374的近侧突起376接合在形成于楔形板中的窗口中，使得夹子输出器374基于楔形板的远侧运动而向远侧前进或运动，如上述关于楔形板180的讨论。
如上所述，夹子输出器374被构造且定尺寸为在最后一个夹子“CL”被排出之后锁定施夹器300。也就是说，当外科施夹器300具有留在夹子通道370中的最后一个夹子“CL”时，输出器374紧邻最后一个夹子“CL”，并且当手柄306被选择性地挤压时，推杆360的远端360c使最后一个夹子“CL”前进到钳夹320中。
在这种结构中，当手柄(未示出)被选择性地挤压(即，致动)时，最后一个夹子“CL”被从施夹器300排出到身体组织。之后，手柄被释放并且如上关于施夹器100所述，推杆360返回到近侧的“初始”位置。基本上是同时，如上所述，夹子输出器374通过楔形板在夹子承载器370内向远侧前进。在这种结构中，推动器末端(pusher tip)360的远端360c布置在夹子输出器374的窗口377内。在施夹器300的这种结构中，夹子输出器374布置在夹子通道370的远端内。可以预期的是，弹性柄脚371的下压力也可以有助于将夹子输出器374保持在夹子通道370的远端。
当第二次挤压手柄时，夹子推动器360的远端360c接合夹子输出器374的窗口377的远端并至少将夹子输出器374的远端推进(即，移动)到钳夹320之间。基本上是同时，手柄被挤压并且带箍343和驱动通道340接合钳夹320的外表面(即，侧面)。
如图20所示，当驱动通道340向远侧运动时，驱动通道340的远侧边缘和/或驱动通道带箍343紧密接合钳夹320的凸轮表面320b。这样，钳夹320朝向彼此接近并且将夹子输出器374摩擦地包含在其间。由于驱动通道带箍343固定到驱动通道340上并且在其间运动，驱动通道带箍343的作用是盖住驱动通道340从而在钳夹320的接近过程中将钳夹320保持在驱动通道340内，并且在施夹器300的操作过程中将楔形板保持在驱动通道340内。然后，当手柄被释放时，如上所述，夹子推动器360向近侧缩回到近侧的“初始”位置。
图22图示了当第三次挤压手柄时夹子输出器374处于锁定位置。在所述结构中，棘爪机构144(如图14中所示)接合到特定点并且手柄在其行程中在基本一半的位置处停止因而被锁定在适当的位置上。如此构造，由于夹子输出器374布置在钳夹320之间，防止了钳夹320再次闭合。在这种结构中，施夹器300处于锁定结构。
在一个实施例中，如图22所示，一个或多个凹口378沿夹子输出器374的侧边缘形成。当夹子输出器374被楔入钳夹320之间或在钳夹320之间做凸轮运动时，凹口378有助于夹子输出器374在横向于主体部374a的平面的方向上的弯曲。这样，如上所述，夹子输出器374可以更容易地遵循钳夹320的弯曲或轮廓。在另一个实施例中，夹子输出器可以被制造为具有能够区分于施夹器300的其它元件的颜色(例如，红色、橙色、黄色、绿色、蓝色等)。这样，着色的夹子输出器374可以向用户表明施夹器300处于锁定状态。
应该理解的是，之前的描述仅仅是本公开示意性的描述。在不脱离本公开的情况下，所属领域技术人员可设计多种替换和修改。因此，本公开旨在包含所有这些替换、修改和变化。参考随附的附图描述的实施例仅仅展示了本公开的特定实例。其它非实质性不同于以上描述和/或随附的权利要求的元件、步骤、方法和技术也希望被包括在本公开的范围内。

Claims (12)

1.一种用于将外科夹子施加到身体组织上的外科施夹器，所述外科施夹器包括：
手柄组件，其包括：
外壳；以及
至少一个手柄，其可移动地连接到所述外壳上；
通道组件，其从所述外壳向远侧延伸出；
夹子承载器，其布置在所述通道组件内且在其中限定了通道，所述夹子承载器的所述通道构造为在其中可滑动地容纳多个夹子；
楔形板，其布置在所述通道组件内；
夹子推杆，其布置在所述外壳和所述通道组件内，所述夹子推杆具有远端以及可操作地连接到所述至少一个手柄上的近端，其中所述夹子推杆的所述远端被构造为与所述多个夹子中的最远侧夹子接合；以及
夹子输出器，其可滑动地布置在所述夹子承载器的所述通道内并且布置在所述多个夹子的近侧，所述夹子输出器包括形成在其主体部中的窗口，其中所述夹子输出器被构造为在所述多个夹子中的最后一个夹子已经被所述外科施夹器排出之后锁定所述外科施夹器，其中在所述至少一个手柄被进一步致动时，所述夹子推杆的所述远端布置在所述夹子输出器的所述窗口内。
2.根据权利要求1所述的外科施夹器，进一步包括：
钳夹组件，其包括从所述通道组件的与所述外壳相反的一端延伸出的一对钳夹，所述钳夹组件适于在其中容纳夹子并且能够响应于所述至少一个手柄的运动进行操作以实现夹子的成型。
3.根据权利要求2所述的外科施夹器，其中，在所述至少一个手柄被进一步致动时，所述夹子推杆的所述远端接合所述夹子输出器的所述窗口的远端并且向远侧推进所述夹子输出器从而移动到所述钳夹之间。
4.根据权利要求3所述的外科施夹器，其中，所述钳夹朝向彼此接近并且所述夹子输出器在所述钳夹之间被推进从而防止所述钳夹闭合。
5.根据权利要求4所述的外科施夹器，其中，在所述至少一个手柄被进一步致动时，棘轮机构被部分地接合从而将所述至少一个手柄锁定在适当的位置上。
6.根据权利要求1所述的外科施夹器，其中，所述夹子输出器布置在所述夹子承载器的所述通道的远端内并且所述夹子承载器的至少一个弹性柄脚的下压力有助于将所述夹子输出器保持在所述夹子承载器的所述通道的所述远端。
7.根据权利要求1所述的外科施夹器，其中，所述夹子输出器被构造为在排出所述多个夹子中的最后一个夹子之后锁定所述至少一个手柄。
8.根据权利要求1所述的外科施夹器，其中，在所述至少一个手柄从致动位置被释放时，所述夹子推杆返回到近侧位置，并且所述夹子输出器大致同时在所述夹子承载器内向远侧前进。
9.根据权利要求1所述的外科施夹器，其中，在所述至少一个手柄从致动位置被释放时，所述夹子推杆向近侧缩回到近侧位置。
10.根据权利要求1所述的外科施夹器，其中，所述夹子输出器沿其每一侧限定了至少一个凹口，并且所述至少一个凹口被构造为有助于使所述夹子输出器在横向于由其主体部限定的平面的方向上弯曲。
11.根据权利要求1所述的外科施夹器，其中，所述夹子输出器被构造为在所述楔形板往复运动时在相对于所述夹子承载器的远侧方向上推进所述多个夹子。
12.根据权利要求1所述的外科施夹器，其中，所述夹子输出器通过所述楔形板的前后往复运动来致动。
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