|Publication number||CN101485582 A|
|Application number||CN 200810135990|
|Publication date||22 Jul 2009|
|Filing date||31 Oct 2008|
|Priority date||31 Oct 2007|
|Also published as||EP2055245A2, EP2055245A3, US20090118762|
|Publication number||200810135990.4, CN 101485582 A, CN 101485582A, CN 200810135990, CN-A-101485582, CN101485582 A, CN101485582A, CN200810135990, CN200810135990.4|
|Inventors||D·阿利西, J·L·哈里斯, L·克雷尼克, M·J·斯托克斯, M·S·蔡纳|
|Export Citation||BiBTeX, EndNote, RefMan|
|Classifications (8), Legal Events (3)|
|External Links: SIPO, Espacenet|
在胃减容术中使用的一次性钉仓 Used in gastric volume reduction surgery disposable cartridge
技术领域 Technical Field
本发明总的涉及胃减容术，尤其是涉及一种在胃减容术过程中用于接近组织的可重载的腹腔镜装置。 The present invention relates generally to gastric volume reduction surgery, particularly to a reloadable laparoscopic device for close tissue during gastric volume reduction surgery. 该腹腔镜装置可释放地连接到含有至少一个紧固件的一次性钉仓。 The laparoscopic device releasably coupled to the at least one fastener comprises a disposable cartridge. 该装置将紧固件从钉仓中展开进入胃腔壁内以促进胃壁的萎缩和腔容积的减小。 This means deploying fasteners from the staple cartridge into the stomach to facilitate and reduce shrinkage cavity volume within the stomach cavity wall.
肥胖是一种影响到美国超过30 %人口的医学病症。 Obesity is an impact on the United States more than 30% of the population of a medical condition. 肥胖影响个人生活质量并显著地增加了发病率和死亡率。 Obesity affect individual quality of life and significantly increased morbidity and mortality. 肥胖最常见地是通过体重指数（BMI)来限定，这是一种考虑到人的体重和身高来测量人体脂肪总量的量度标准。 Obesity is most commonly by body mass index (BMI) is defined, which is a consideration of the person's weight and height to measure a measure of total body fat. 这是一种简单、快速且廉价的量度标准，其与发病率和死亡率两者都相关。 This is a simple, fast and inexpensive measure of which are associated with both morbidity and mortality rates. 超重被定义为BMI 在25至29.9 kg/m2，肥胖被定义为BMI 30 kg/m2。 Overweight is defined as BMI 25 to 29.9 kg / m2, obesity is defined as BMI 30 kg / m2. 病态肥胖被定义为BMI》40kg/n^或超重100 lbs。 Morbid obesity is defined as BMI "40kg / n ^ or overweight 100 lbs. 估计肥胖及其并发症每年在直接和间接的健康护理费用就超过1000亿美金。 Estimated that obesity and its complications every year in direct and indirect health care costs to more than 100 billion dollars. 与肥胖有关的并发症包括2型糖尿病、心血管疾病、高血压、血脂异常、胃食管逆流病、障碍式睡眠呼吸暂停、尿失禁、不孕、承重关节的骨关节炎以及一些癌症。 Complications associated with obesity including type 2 diabetes, cardiovascular disease, hypertension, dyslipidemia, gastroesophageal reflux disease, disorder type sleep apnea, incontinence, infertility, weight-bearing joints of osteoarthritis and some cancers. 这些并发症会影响到人体的所有系统，并且可消除对肥胖只是一种美容问题的误解。 These complications can affect all systems of the body, and can eliminate misconceptions about obesity is just a cosmetic problem. 研究表明仅用饮食和锻炼的保守治疗并不能有效减轻许多患者的体重。 Studies have shown that conservative treatment with only diet and exercise are not effective to reduce the weight of many patients.
肥胖病学是涉及控制和治疗肥胖的医学分支。 Bariatrics is involved in the control and treatment of obesity branch of medicine. 在肥胖病学领域中已经开发出各种不同的外科手术来治疗肥胖。 In the field of obesity have been developed a variety of surgical procedures to treat obesity. 现在最常实施的手术是鲁氏Y形胃旁路术（RYGB)。 Now the most frequently performed surgery is Roux-Y gastric bypass (RYGB). 该手术非常复杂并且常常被用来治疗显示病态肥胖的人。 This procedure is highly complex and is often used to treat morbidly obese people show. 在RYGB术中， 一个小胃嚢从胃腔的剩余部分分离出来并被连接到小肠的切除部位。 In RYGB surgery, a small stomach Nang separated from the remainder of the gastric cavity and connected to cut out parts of the small intestine. 小肠的切除部位被连接在"较小"胃嚢和小肠远侧部之间，允许食物在它们 Cut off portion of the small intestine is connected between the "smaller" distal portion of the stomach and small intestine Nang, allowing food in them
之间经过。 Between pass. 传统的RYGB术需要大量的手术时间并且具有与手术有关的风险。 Traditional surgery RYGB surgery requires a lot of time and risks associated with surgery. 由于侵入的程度，术后恢复可能是非常漫长和痛苦的。 Because of the degree of invasiveness, post-operative recovery can be quite lengthy and painful. 仅在美国，每年仍有超过100,000例RYGB术被实施，这在健康护理上花费了大量美金。 In the US alone, there are more than 100,000 cases per year RYGB surgery is implemented, it took a lot of dollars in health care.
考虑到RYGB术的高侵入性特性，开发了其他侵入性较少的手术。 Taking into account the highly invasive surgery RYGB features developed other less invasive surgery. 这些手术包括胃束带捆扎术，其将胃收缩形成沙漏的形状。 These procedures include gastric banding surgery, which will form the shape of an hourglass stomach contractions. 该手术限制了从胃的一部分通到胃的下一部分的食物量，进而早早产生饱胀感。 This procedure restricts pass from one part of the stomach to stomach the amount of food the next section, and then early sense of fullness. 带在靠近胃和食道的汇合处绕着胃设置。 Belt near the confluence of the stomach around the esophagus and stomach settings. 上部小胃嚢很快就被填满了，并且慢慢地通过狭窄的出口排空来产生饱胀感。 The small upper stomach Nang will soon be filled, and slowly emptied to produce a sense of fullness through the narrow exit. 除了外科手术并发症，经受胃束带捆扎术的患者还可能会遭受食管损伤、脾损伤、带滑脱、储器紧缩/泄漏以及持续的呕吐。 In addition to surgical complications in patients subjected to gastric banding surgery also may suffer from esophageal injury, spleen injury, band slippage, reservoir tight / leak, and persistent vomiting. 其他为治疗肥胖开发的治疗肥胖病的手术形式包括福比袋（Fobi pouch )、胆-胰转流术、竖直捆扎胃成形术和胃袖套成形术。 Other forms of therapy for the treatment of obesity development of obesity surgery, including blessing than bags (Fobi pouch), biliary - pancreatic bypass, vertical gastroplasty and gastric banding cuff angioplasty. 因为这些包括RYGB在内的手术的一些方面涉及对一部分胃进行钉合，所以许多治疗肥胖病的手术通常被称为"胃钉合（stomach stapling )，，术。 Because some of these aspects include surgery, including RYGB involve stapling a portion of the stomach were so many surgical treatment of obesity is often called "stomach stapling (stomach stapling) ,, surgery.
对于病态肥胖的个人，由于个人面临的严重健康问题和死亡风险，RYGB、胃束带捆扎术或其他更复杂的手术可能会是值得推荐的治疗方法。 For morbidly obese individuals, due to the risk of serious health problems and death faced by individuals, RYGB, gastric banding surgery or other more complex surgical treatment may be recommended. 然而，在美国和其他地方越来越多的人口虽然超重但并不是病态肥胖。 However, in the United States and elsewhere, although more and more people are overweight but not morbidly obese. 这些人可能超重20至30磅并且想要减肥，但仅仅通过饮食和锻炼却没能成功。 These people may 20-30 pounds overweight and want to lose weight, but just failed to succeed through diet and exercise. 对于这些个人，与RYGB 或其他复杂手术关联的风险通常超过可能获得的健康收益和花销。 For these individuals, the risks associated with the RYGB or other complex procedures are usually more than health benefits and expenses may be available. 相应地，治疗的选择应涉及更少侵入性、更低成本的减肥解决方案。 Accordingly, the treatment of choice should involve less invasive, lower cost solution for weight loss. 另外，众所周知的是适当的减少体重可以显著地降低并发病症的影响，其中包括但不限于2型糖尿病。 In addition, it is known to reduce the proper weight can significantly reduce the impact of concurrent disorders, including but not limited to type 2 diabetes. 还是由于这个原因，具有特别安全的特点的低费用、低风险的手术将为患者和健康护理业者提供显著的收益。 Or because of this reason, the low cost of special security features, low-risk surgery for patients and health care industry to provide significant benefits.
众所周知的是，仅通过内窥镜术来形成腔壁折襞就是一种治疗肥胖的方法。 It is well known only to form a cavity wall plication is a method of treating obesity by endoscopy. 然而，在胃腔内部单独地操作限制了不用切开所能达到的折襞深度。 However, in the stomach cavity alone operation without cutting limits the plication depth that can be achieved. 此外，在纯内窥镜术中，胃腔内的通路和能见度会随着减少范围的增加而受到限制。 In addition, the purely endoscopic surgery, the stomach cavity of access and visibility will increase with the reduction of the scope is limited.
已经发展了内窺镜/腹腔镜混合外科手术，其用于使胃腔壁萎缩以减小胃容积。 We have developed an endoscopic / laparoscopic surgery mixing, which is used to shrink the stomach cavity wall to reduce stomach volume. 在混合式胃减容（GVR)术中，成对的缝线锚定装置通过胃腔壁展开。 In the hybrid gastric volume reduction (GVR) technique, pairs of suture anchoring device through the stomach wall-start. 随着锚定器的展开，连接到每对锚定器上的缝线收紧并固定从而使腔壁萎缩。 As the anchor of the expanded suture attached to each pair of anchors on tightening and shrinking fixed so that the cavity wall. 该手术在序列号为 The operation sequence number
11/779314和11/779322的共同未决的美国专利申请中更加详细地描述，所述专利申请通过引用结合于此。 Co-pending US patent application 11/779314 and 11/779322 are described in more detail in the patent applications incorporated herein by reference.
为了辅助内窥镜/腹腔镜GVR混合手术（例如减小胃成形术）， 就需要一种简单、低成本的装置来将紧固件展开进入胃腔中。 To assist endoscopic / laparoscopic GVR hybrid operation (such as reduced gastroplasty), a need for a simple, low-cost means to expand the fastener into the stomach cavity. 尽管GVR术可用针和缝线实施，但是所述的方法需要高度熟练的外科医生并且很耗时间。 Although GVR surgical needle and suture embodiment, but the method requires a highly skilled surgeon and can be time consuming. 相应地，就需要有一种能响应外科医生做出的一组触发动作将紧固件释放的装置。 Accordingly, it is necessary to have a responsive device made by a group of surgeons triggering will release fastener. 就需要装置通过腹腔镜端口展开紧固件来保持手术的最小侵入性特性。 We need to expand the fastener by means of laparoscopic port to maintain the minimally invasive surgical characteristics. 另外地，需要有一种廉价且容易使用的腹腔镜紧固件展开装置。 Additionally, there is a need for inexpensive and easy to use laparoscopic fastener deploying device. 另外，需要有一种能简单且快速地重载的紧固件展开装置，以便装置能够可重复地展开外科医生所认为需要的那么多的紧固件。 In addition, there is a need to be able to easily and quickly reload a fastener deploying device to device can be repeatedly surgeon needs to expand so much that the fasteners. 需要的是，紧固件被包装在容易装载的钉仓中，以便手术能快速且安全地实施。 It requires that the fasteners be packaged in easily loaded cartridge in order to be able to quickly and safely operative embodiment. 本发明提供了一种可重载的紧固件展开装置和匹配的可更换的紧固件钉仓，以完成这些目标。 The present invention provides a reloadable fastener deploying device and matching replaceable fastener cartridge to accomplish these goals.
本发明涉及一种含有紧固件的钉仓，其中，所述钉仓可释放地连接到紧固件展开装置上。 The present invention relates to a cartridge containing a fastener, wherein the cartridge releasably connected to a fastener deploying device. 钉仓具有壳体，该壳体容纳至少一个组织穿刺构件。 Cartridge having a housing accommodating at least one tissue penetrating member. 穿刺构件至少部分地容纳紧固件。 Piercing member is at least partly accommodating fasteners. 紧固件具有至少两个通过松弛构件连接在一起的刚性锚定器。 Fastener has at least two connecting members together by relaxing rigid anchor. 所述钉仓还包括用于将钉仓可拆卸地连接到展开装置上的部件。 The cartridge further comprises a cartridge removably coupled to the expandable member on the apparatus.
本发明具体地涉及以下内容： The present invention particularly relates to the following:
(1) 一种包含紧固件的钉仓，包括： (1) comprising a fastener cartridge comprising:
a. 钉仓，其可释放地连接到紧固件展开装置；其中 . a cartridge, which can be releasably connected to a fastener deploying device; wherein
b. 所述钉仓包括容纳有至少一个组织穿刺构件的壳体； . b The cartridge comprises receiving at least one tissue penetrating member housing;
c. 所述穿刺构件至少部分地容纳有紧固件；其中 . c The piercing member is at least partially accommodating fasteners; wherein
d. 所述紧固件包括至少两个由松弛构件连接在一起的刚性锚固件；以及 . d the fastener comprises at least two rigid anchors connected together by a relaxation member; and
e. 用于将所述钉仓可拆卸地连接到展开装置的部件。 e. for the cartridge member detachably connected to the expansion device.
(2) 如第（1)项所述的钉仓，还包括用于切断所述缝线的切割器。 (2) Subsection (1) of the staple cartridge, further comprising means for cutting said suture cutter.
(3) 如第（1)项所述的钉仓，其中，所述缝线在所述紧固件被展开前完全地包含在所述壳体内。 Said cartridge (3) Subsection (1), wherein the suture completely contained within the housing before the fastener is deployed.
(4) 如第（1)项所述的钉仓，其中，所述组织穿刺构件能在所述壳体内运动。 (4) If the cartridge as described in (1) above, wherein the tissue penetrating member can move within the housing.
(5) 如第（1)项所述的钉仓，其中，所述组织穿刺构件包含用于使组织损伤最小化的部件。 (5) Subsection (1) of the staple cartridge, wherein the tissue penetrating member comprising means for minimizing tissue damage components.
附图说明 Brief Description
图1是示例性的缝线锚定器展开装置和相连的钉仓的立体 Figure 1 is an exemplary suture anchor deployment device and connected to a stereo cartridge
图2是第一联接实施方式的钉仓联接构件和壳体远端的简化的立体图； Figure 2 is a cartridge coupling member and the distal end of the housing a simplified perspective view of a first embodiment of the coupling;
图3是第一联接实施方式的简化的立体图，显示了联接到壳体上的钉仓； Figure 3 is a simplified perspective view of a first embodiment of the coupling, showing the cartridge coupled to the housing;
图4A是钉仓和壳体远端的简化的立体图，显示了壳体上的一种可选的联接构件； 4A is a simplified perspective view of the distal end of the cartridge and the housing, showing an alternative coupling member on the housing;
6图4B是钉仓和壳体远端简化的立体图，显示了在壳体上另一种可选的联接构件； 6 and FIG. 4B is a cartridge housing distal simplified perspective view showing a housing in an alternative coupling member;
图5是钉仓和壳体远端的侧视图，显示了将钉仓联接到壳体上的第二实施方式； Figure 5 is a distal end of the cartridge and the housing side view showing a cartridge coupled to the second embodiment of the housing;
图6是与图5相似的侧视图，显示了根据图5的联接实施方式的联接到壳体上的钉仓； Figure 6 is a side view similar to FIG. 5, showing an embodiment of the connection coupling according to FIG. 5 to the housing of the cartridge;
图7是钉仓的立体图，显示了钉仓的远端及其一侧； 图8是图7中所示的钉仓的远端视图； Figure 7 is a perspective view of the cartridge showing the distal end of the cartridge and the side; Fig. 8 is a distal end of the cartridge shown in FIG. 7 view;
图9是图7中所示钉仓的第二立体图，显示了钉仓的近端和顶部； FIG. 9 is shown in FIG. 7 of a second cartridge perspective view showing the proximal and the top of the cartridge;
图IO是图7中所示的钉仓的近端视图； Figure 7 IO is the staple cartridge shown in FIG proximal view;
图11是图7中所示的钉仓的分解视图； FIG. 11 is shown in the magazine 7 an exploded view;
图12是示例性的T形凸片（T-Tag)锚定装置的立体图； 12 is a perspective view of an exemplary T-Tag (T-Tag) anchoring device;
图13是在一对T形凸片锚定器之间形成的滑结的立体图，显示了活结的松开形式； Figure 13 is a perspective view of the slip knot between a pair of T-Tag anchor is formed, showing the release form slipknot;
图14是第二示例性T形凸片锚定装置的侧视图，显示了用于形成缝线环的第二种方法； FIG 14 is a second side view of an exemplary T-Tag anchor apparatus, showing a second method for forming a suture loop;
图15A是可用在图7的钉仓内的针的第一实施方式的立体 15A is a perspective view of the needle within the cartridge of FIG. 7 of the first embodiment
图15B是在图15A中所示的针的剖面图； 15B is a sectional view of the needle shown in FIG. 15A;
图16是局部立体剖视图，显示的是针的第二实施方式，其中 Figure 16 is a partial perspective cross-sectional view showing the second embodiment of the needle, wherein
针在钉仓内从其中延伸； Wherein the needle extends from within the cartridge;
图17是图16中显示的针的另一立体图，显示了用于展开T Figure 17 is another perspective view of the needle 16 shown in FIG, showing for deploying T
形凸片锚定器的针尖开口； -Tag anchor tip opening;
图18A至18C是其他可选的针结构的立体图； 18A to 18C is a perspective view of another alternative needle structures;
图19是图1中所示的展开装置和钉仓的立体剖视图； 19 is a sectional perspective view of the expansion device and the cartridge shown in Figure 1;
图20是图19中所示的展开装置的分解视图； Figure 20 is an exploded view of the expansion device shown in Fig. 19;
图21是展开装置手柄的立体图，从近侧方向看手柄外套被部 Figure 21 is a perspective view of the deploying device handle, viewed in the direction from the proximal portion of the handle jacket is
7分地去除，显示出在其远侧位置的壳体和处于初始位置的致动机 7 partially removed, showing the housing in its distal position and in the initial position of the actuating
图22是钉仓从近端截取的局部剖视图，显示了在针和推杆护套上的连接构件； Figure 22 is a sectional view taken from the proximal end of cartridge, showing the connecting member and putting the needle sheath;
图23是手柄中致动机构的分解立体图； Figure 23 is an exploded perspective view of the handle of FIG actuation mechanism;
图24是展开装置手柄的第二立体剖视图，显示了在一侧向下倾斜的手柄； Figure 24 is a perspective cross-sectional view of the second deploying device handle, showing the handle in a downward sloping side;
图25是用于展开装置的缝线收紧组件和壳体的分解视图； 图26是展开装置和钉仓在紧固件展开之前的初始匹配状态的剖视图； FIG 25 is a device for deploying an exploded view of the suture cinching assembly and housing; FIG. 26 is a sectional view of the deploying device and cartridge in an initial matching prior state of the fastener deploying;
图27是展开装置和钉仓的剖视图，显示出为了从钉仓中暴露出针而缩回的4丁仓和壳体； FIG. 27 is a sectional view of the expansion device and cartridge, showing the needle to expose retracted from the staple cartridge 4 small warehouse and housing;
图28是展开装置和钉仓的剖视图，显示了从针上弹出的第一T形凸片锚定器； Figure 28 is a cross-sectional view of the device and cartridge unfolds, shows the ejection from the needle first T-Tag anchor;
图29是展开装置和钉仓的剖视图，显示了在第二T形凸片锚定器展开之前释放的扳机； 29 is a sectional view of the deploying device and cartridge, showing before the second T-Tag anchor is deployed release of the trigger;
图30是展开装置和钉仓的剖视图，显示了为了从针上弹出第二T形凸片锚定器而向近侧枢转的扳机； Figure 30 is a cross-sectional view of the device and the staple cartridge expands to display the To pop the second T-shaped pin protruding from the anchor and the proximal pivoting trigger;
图31是展开装置和钉仓的剖视图，显示了完全枢转后的扳机和在装置内复位的致动机构； Figure 31 is a sectional view of the expansion device and cartridge showing the trigger fully pivoted and after actuating mechanism within the device reset;
图32是展开装置和钉仓的剖视图，显示了复位至初始位置的致动机构，和在壳体内缩回的针； 32 is a cross-sectional view of the device and the staple cartridge expands to reveal reset to the initial position of the actuating mechanism, and the needle is retracted within the housing;
图33是展开装置和钉仓的剖视图，显示了在钉仓的远侧尖端处收紧在一起的T形凸片锚定器； 33 is a sectional view of the device and cartridge unfolds, showing cinched together at the distal tip of the cartridge of T-Tag anchor;
图34是展开装置和钉仓的立体图，显示了从T形凸片锚定器延伸并接合钉仓上的切割构件的缝线； FIG. 34 is a deploying device and cartridge perspective view showing the T-Tag anchors extend and engage the cutting member on the suture cartridge;
图35是展开装置的第二种实施方式的立体图，所示展开装置连接到钉仓； Figure 35 is a perspective view of a second embodiment of the deploying device, the expansion means is connected to the cartridge shown;
8图36是展开装置的第二种实施方式和连接的钉仓的立体图， 图中手柄外套^皮部分地去掉； 8 apparatus 36 is expanded and connected to a second embodiment of a perspective view of the cartridge, the handle housing ^ FIG sheath partially removed;
图37是用于展开装置的第二种实施方式的壳体和手柄的局部分解图； FIG 37 is a partially exploded view of a second embodiment for the deploying device housing and handle manner;
图38是钉仓和展开装置的第二种实施方式的剖视图，显示出钉仓处在覆盖了针的完全远侧位置； Figure 38 is a cartridge and a sectional view of a second embodiment of the apparatus expands to reveal the magazine covers the needle completely at a distal position;
图39是与图38相似的剖面视图，显示了为了使针完全从钉仓远端暴露出来并且将推杆向前推入钉仓中而部分缩回的钉仓； FIG 39 is a cross-sectional view similar to FIG. 38, showing the needle fully exposed to the distal end of the cartridge and the push rod forward to push out the staple cartridge into the staple cartridge partially retracted;
图40是与图39相似的剖面视图，显示了为了使推杆与针中的T形凸片锚定器堆叠相接触而完全缩回的钉仓和壳体； FIG. 40 is a cross-sectional view similar to Figure 39 showing the plunger and the needle in order to make the T-Tag anchor stack contacting the fully retracted cartridge and housing;
图41是展开装置的第二种实施方式的手柄的分解视图； Figure 41 is an exploded view of the expansion device of the second embodiment of the handle;
图42是外部外套去掉后的手柄的侧视图，显示了用于对装置的致动机构进行复位的另一种实施方式； Figure 42 is a side view of the handle after the outer jacket removed, showing another embodiment of the actuating mechanism for resetting the device;
图43是与图42相似的手柄侧视图，显示了完全枢转后的扳机和在装置内复位的致动机构； FIG. 43 is similar to FIG. 42 handles side view showing the trigger fully pivoted and after actuating mechanism within the device reset;
图44是展开装置的第二实施方式的手柄的分解视图，显示了与图41中所示的手柄的侧面相对的侧面； Figure 44 is an exploded view of the handle of the expansion device of the second embodiment, the display side and the side of the handle shown in FIG. 41 relative;
图45是展开装置的第二种实施方式和连接的钉仓的立体图， 图中去掉了手柄的外套并其是从图36中所示的装置的相对侧看的； FIG. 45 is a deploying device connected to a second embodiment and a perspective view of the cartridge, the figure removed the handle of the jacket and it is from the opposite side of the device shown in FIG. 36 to see;
图46是展开装置和连接的钉仓的第三种实施方式的立体图， 图中部分地去掉了手柄外套； 46 is a perspective view of the deploying device and attached cartridge of the third embodiment, the figure is partially removed the handle casing;
图47是第三种实施方式的钉仓的立体图，显示了钉仓的第一侧和远端； 47 is a perspective view of a third embodiment cartridge, showing the cartridge of a first side and a distal end;
图48是第三种实施方式的钉仓的立体图，显示了从图47中所示的视图绕钉仓轴线旋转180°后的钉仓； 图49是第三种实施方式的钉仓的近端视图； 图50是展开装置和连接的钉仓的第三种实施方式的侧视图，显示了外部外套被部分地去掉的手柄和向远侧行进的钉仓和壳 Figure 48 is a third embodiment of the cartridge of a perspective view showing the cartridge about the axis of rotation from the view shown in FIG. 47 180 ° after the cartridge; Fig. 49 is a third embodiment, the proximal end of the cartridge view; FIG. 50 is a side view of the expansion device and the attached cartridge of a third embodiment, showing the exterior coat is partially removed the handle and distally of the cartridge and shell
图51是与图50相似的展开装置和连接的钉仓的侧视图，显示了为了暴露针的远端而位于在完全缩回的近侧位置的壳体和钉 FIG. 51 is similar to the expansion device 50 and the attached cartridge side elevational view of the distal end of the needle to expose located in the fully retracted position of the housing and the proximal nail
图52是显示了展开装置和连接的钉仓的第四种实施方式的立体图； Figure 52 is a perspective view showing the connection of expansion device and cartridge of the fourth embodiment;
图53是根据第四种实施方式的展开装置和钉仓的剖视图，显示了位于覆盖了针的完全远侧位置的外部保护套； Figure 53 is a sectional view of a fourth embodiment of the expansion device and cartridge, showing the cover of the external protective sleeve is located fully distal position of the needle;
图54是与图53相似的展开装置和钉仓的剖视图，显示了为了暴露针而位于部分缩回位置的外部保护套； Figure 54 is a cross-sectional view similar to FIG. 53 and staple cartridge unit expands to display the external protective sheath to expose the needle and located partially retracted position;
图55是与图54相似的展开装置和钉仓的剖视图，显示了为了暴露钉仓联接构件以使钉仓能够去掉而位于完全缩回位置的外部保护套； Figure 55 is a cross-sectional view of the apparatus of FIG. 54 and staple cartridge similar expands to display the order to expose the cartridge coupling member to the cartridge can be removed in the fully retracted position and an outer protective jacket;
图56是钉仓的第四种实施方式的分解视图； Figure 56 is an exploded view of a fourth embodiment of the staple cartridge;
图57是根据第四种实施方式的钉仓的立体图； Figure 57 is a perspective view of the fourth embodiment of cartridge;
图58是从近端看的第四种实施方式的钉仓的立体图； Figure 58 is a perspective view looking from the proximal end of the fourth embodiment of cartridge;
图59是患者在内窺镜-腹腔镜混合手术期间的示意图； 59 patients in the endoscope - Drawing laparoscopic surgery during mixing;
图60是腹壁和胃腔的剖视图，显示了处于用于在腹膜腔中探 Figure 60 is a cross-sectional view of the abdominal wall and gastric cavity showing in for exploration in the peritoneal cavity
查组织的展开装置远端处的钉仓； Check the organization's expansion cartridge device at the distal end;
图61是腹壁和胃腔的剖视图，显示了处于用于探查胃腔以获 FIG 61 is a cross-sectional view of the abdominal wall and gastric cavity showing the probe in the stomach cavity to eligible for
得第二缝线锚定器位置的展开装置远端处的钉仓； Cartridge device was launched at the distal end of the second suture anchor position;
图62是腹壁和胃腔的剖视图，显示了在胃腔壁中形成并锁定 FIG 62 is a cross-sectional view of the abdominal wall and gastric cavity showing the formation and locked in the cavity wall of the stomach
成皱襞的紧固件； Into the folds of fasteners;
图63是胃腔的外部概略视图，显示了两组紧固件的放置；以 Figure 63 is a schematic view of an external stomach, showing the placement of two fasteners; to
图64是沿着图63中线64-64截取的剖视图，显示了具有均一壁皱襞的胃腔内部。 Figure 64 is a sectional view taken along 64-64 63 midline, showing the interior of the gastric cavity wall folds have both. 具体实施方式 DETAILED DESCRIPTION
现在参见附图，其中在所有视图中同样的附图标记代表同样的部件，图1示出了本发明的第一种示例性的紧固件展开装置20。 Referring now to the drawings, in which all views like reference numerals represent like parts, Figure 1 shows a first exemplary fastener deploying device 20 of the present invention.
如图1中所示，紧固件展开装置包括用于操纵装置的手柄22。 As shown in Figure 1, the fastener deploying device includes a handle 22 for manipulating the device. 手柄22包括手枪式握把24和至少一个致动器。 Handle 22 includes a pistol grip 24 and at least one actuator. 致动器包括可手动活动的扳机26。 The actuator includes a manually movable trigger 26. 细长的管状壳体30从手柄22向远侧延伸。 An elongated tubular housing 30 extends distally from the handle 22. 壳体30的长度（大约18，，）足够使其在肥胖患者体内众多套管针进入部位处使用。 Length (approximately 18 ,,) of the housing 30 is sufficient to make obese patient at numerous trocar access sites. 同样地，壳体30的尺寸允许小直径（3至5mm)套管针通过。 Similarly, the size of housing 30 allows a small diameter (3 to 5mm) trocar through.
紧固件展开装置20设计成与可更换的紧固件钉仓一起使用。 Fastener deploying device 20 is designed to be used with a replaceable fastener cartridge. 如图1中所示，紧固件钉仓32被可释放地连接在壳体30的远端。 As shown in Figure 1, the fastener cartridge 32 is releasably connected to the distal end 30 of the housing. 钉仓32的尺寸和形状能够在连接到展开装置时允许3至5mm的套管针通过。 Cartridge 32 can be sized and shaped to allow the connection of 3 to 5mm trocar when expanded by means. 联接构件定位于壳体30的远端和钉仓32的近端以便可释放地将钉仓连接在展开装置上。 The coupling member is positioned at the distal end of the cartridge housing 30 and the proximal end 32 so as to be releasably connected to the cartridge to expand the device. 钉仓联接构件使得钉仓能够快速安全地去除和替换。 Cartridge coupling members so that the cartridge can be removed and replaced quickly and safely. 图2和3是钉仓32和壳体30的简化视图，示出了用于将钉仓联接到壳体远端上的第一种实施方式。 Figures 2 and 3 is a simplified view of the cartridge 32 and the housing 30, there is shown a first embodiment of the distal end of the housing for the cartridge is coupled to. 在该实施方式中，联接构件包括一对在钉仓的主体上沿周向偏移、沿纵向延伸的开放通道。 In this embodiment, the coupling member includes a pair of cartridge on the body circumferentially offset, longitudinally extending open channels. 第一个开放通道34从钉仓的近端向远侧延伸到恰好超过第二开放通道36近端的点。 The first open channel 34 extends from the proximal end of the cartridge distally to just over a second open channel 36 proximal point. 每个开放通道34、36具有平滑的凹面。 Each open channel 34, 36 has a smooth concave surface. 凸起部定位在壳体30的远端上以便与开放通道34、 36滑动接合。 Protrusion positioned at the distal end of the housing 30 for use with open channels 34, 36 in sliding engagement. 如图2中所示，凸起部可包含径向向内的凹部40，其配合在通道34、 36内并沿着通道34， 36的平滑轮廓滑动。 As shown in Figure 2, a radially inwardly projecting portion may comprise a recess 40, which fit in the channel 34, 36 and 34, 36 slide along the smooth contour of the channel.
为了将钉仓32连接到壳体30上，凹部40与第一开放通道34对准并插入其中。 To connect cartridge 32 to the housing 30, the first opening 40 and the passage recess 34 aligned and inserted therein. 在插入之后，凹部40就沿着开》文通道的长度向远侧滑动直到壳体30的远端或凹部40接触到了钉仓32为止。 After insertion, the recess 40 is open along the "length of the text passage slid distally until the distal end of the housing recess 40 or 30 come into contact with the cartridge 32 so far. 在第一开放通道34的远端处，钉仓32相对于壳体30旋转以 In the first open channel at the distal end 34, the cartridge 32 is rotated relative to the housing 30
ii使凹部40从第一开放通道的远端跳到第二开放通道36的近端，如在图3中所示。 ii the concave portion 40 of the second open channel to jump from the distal end of the proximal end of first open channel 36, as shown in FIG. 3. 凹部40是由半刚性的材料组成，以便在使用中抵抗旋转，但在钉仓相对于壳体旋转时凹部40会发生变形、偏斜或者其他短暂的移动以便凹部能够从第一开放通道跳到第二开放通道从而将钉仓固定到壳体上。 The recess 40 is a semi-rigid material, so as to resist rotation during use, but in the cartridge relative to the recess 40 occurs when the housing rotating deformed, skew or other short-term movement in order to be able to jump from the first recess open channel The second open channel so that the cartridge is fixed to the housing. 图4A和4B示出了凹部40的可选构造。 4A and 4B illustrate alternative constructions of the recessed portion 40. 在三种实施方式的每一种中，凹部40，或40'，通过压印、切割或其他方式靠近远端形成在壳体30中，以提供从壳体的圓周向内延伸的凸起部，同时保持与壳体的至少一部分连接。 In each of the three embodiments, the recesses 40, or 40 ', by embossing, cutting or otherwise formed in the housing near the distal end 30 to provide a protrusion extending inwardly from the circumference of the housing while maintaining the connection with at least a portion of the housing. 为了从壳体30上去除钉仓32,钉仓沿着与其在连接过程中旋转的方向相反的方向相对于壳体^走转，从而再一次-使凹部40发生变形并且使得凹部从第二开放通道36跳回到第一开》文通道34。 In order to remove from the housing 30 cartridge 32, the cartridge is connected along its course in the direction opposite to the direction of rotation relative to the housing ^ go forward, so again - the concave portion 40 is deformed and makes the recess from the second open jump back to the first open channel 36 "Wen channel 34. 然后，凹部4 0通过第一开放通道3 4向近侧滑动以便从壳体上分离钉仓。 Then, the recess 40 through the first open channel 34 to slide proximally to separate the cartridge from the housing.
图5和6示出了将钉仓32联接到壳体30远端的可选实施方式。 Figures 5 and 6 illustrate a cartridge 32 coupled to the distal end of the housing 30 an alternative embodiment. 在该实施方式中，联接构件包括弹簧42、可滑动的锁定部44和钉仓32上隆起的凸片46。 In this embodiment, the coupling member includes a spring 42, slidable lock portion 44 and the cartridge 32 raised lug 46. 一"L"形切口50形成在壳体30的远端中并与隆起的凸片46相匹配。 An "L" shaped cutout 50 is formed at the distal end of the housing 30 and the raised lug 46 matches. 为了将钉仓32联接到壳体30，钉仓的近端被推进壳体的远端，从而隆起的凸片46就滑下到"L"形切口50的槽内。 For the cartridge 32 is coupled to the housing 30, the proximal end of the cartridge is advanced distal end of the housing, thus raised lug 46 to slide down to the "L" shaped cutout groove 50. 随着钉仓32滑进壳体30,锁定部44在钉仓的长度上向远侧滑动，压缩弹簧42。 With the cartridge 32 slide into the housing 30, the locking portion 44 to slide distally over the length of the cartridge, the compression spring 42. 当隆起的凸片46在"L"形切口50中降到最低点时，钉仓32相对于壳体30旋转以便将凸片46在圆周方向上滑动通过切口50的下段从而将钉仓锁定在壳体上，如图6中所示。 When 46 at the "L" shaped incision 50 to a minimum, the cartridge 32 relative to the housing 30 is rotated so that the tabs 46 slide raised lug through an incision in the circumferential direction under section 50 so that the cartridge is locked in On housing, as shown in FIG. 当凸片46被锁定进壳体切口50时，弹簧42处于轻微的压缩状态以使得锁定部44与切口保持接触。 When 50 tab 46 is locked into housing cutout, spring 42 is slightly compressed state so that the locking portion 44 remains in contact with the incision. 为了从壳体30上去除钉仓32，将锁定部44沿着钉仓向远侧滑离切口50。 30 In order to remove the cartridge from the housing 32, the lock portion 44 along the cartridge to slip away from the notch 50. 然后，钉仓相对于壳体沿相反方向旋转，以便凸片46滑动通过并滑出"L"形切口50。 Then, the cartridge relative to the housing in the opposite direction of rotation, so that the tabs 46 slide and slide through the "L" shaped cutout 50.
现在转到图7到11，其中详细地示出了可替换钉仓的第一种实施方式。 Turning now to Figure 7-11, which shows in detail replaceable cartridge of the first embodiment. 如图中所示，钉仓32包含至少一个紧固件和用来将紧固件放置到身体内的组织穿刺构件。 As shown, cartridge 32 contains at least one fastener and means for placing the fastener into the tissue penetrating member within the body. 穿刺构件可以是具有开槽内腔的针52，该开槽内腔从部分或完全磨尖的尖端向近侧延伸通过 Piercing member can be a needle having a slotted lumen 52, which partially or completely from a slotted lumen sharpened tip extends proximally through
针的长度来保持至少一个紧固件。 Length of the needle to keep at least one fastener. 针52可以由注模塑料制成、由塑料、金属或陶瓷材料挤压而成、或者在顺序冲模操作中由金属片制成。 Needle 52 may be made of injection molded plastic, made of plastic, metal or ceramic material extruded, or progressive die operation made of a metal sheet. 各种不同的处理、涂层和机械变型方案都可以用来增强针的锋锐程度。 Various processes, coatings, and mechanical variant can be used to enhance the degree of sharpened needle. 在下面所示和介绍的实施方式中，针至少部分保持并展开单个的紧固件。 In the embodiment shown and described below, the needle at least partially retains and deploys a single fastener. 然而，可以想到的是，包容多于一个紧固件的针可以被开发出来用于与展开装置一起使用，这并不脱离本发明的范围。 However, it is conceivable that the inclusion of more than one fastener pin can be developed for use with the expansion device, it is not departing from the scope of the invention. 紧固件包括一对通过不可回弹的柔性或软弛材料(例如缝线）彼此相连的锚定装置。 Fastener comprises a pair of anchoring means through non-resilient flexible or soft material relaxation (e.g., sutures) connected to each other. 单纤维和编织缝线是用于该紧固件的示例性材料，由于连接两个优选为刚性的锚定装置的材料理想地是由当遭受到压缩负载时能够抵抗变形的材料（近似于绳子的材料）。 Monofilament and braided sutures are exemplary fastener for the material, since the material connecting the two preferably rigid anchoring devices is ideally made when the material is subjected to a compressive load to resist deformation (similar to a rope material). 二维柔性构件比如带状物也可用到。 Dimensional flexible members such as ribbons can also be used to. 在此介绍的实施方式中，锚定装置是T形凸片型缝线锚定器，这是在图12中所示的一实施方式。 In the embodiment described here, the anchoring means is a T-Tag type suture anchors, which is an embodiment shown in FIG. 12. 该示例性T形凸片锚定器54包含细长的管筒56，该管筒56具有在管筒大约一半的长度上延伸的开口或槽60。 This exemplary T-Tag anchor 54 comprises an elongate tube 56, the tube 56 has approximately half the length of the tube openings or slots 60 extend. 管筒剩余的长度形成了封闭的圆柱形。 The remaining length of the tube to form a closed cylindrical. 缝线62长度的一端插入到管筒的封闭长度内。 One end of a length of suture 62 is inserted into the closed length of tubing. 通过巻折圆柱长度的中间部分将缝线末端保持在管筒内，如箭头64所示。 Volume by folding the intermediate portion of the length of the cylinder is maintained at the end of a tube of the suture, as shown by arrow 64. 缝线62剩余的长度自由地从槽60中突出。 The remaining length of suture 62 freely protruding from the slot 60. 沿着T形凸片锚定器56的长度可以形成向外延伸的突起部分或膨胀部分66。 Along the T-Tag anchor 56 may be formed to extend the length of the outwardly protruding portion 66 or the expansion portion. 当锚定器被保持在针的内腔中时，膨胀部分66在针的内径和T形凸片锚定器之间产生摩擦力。 When the anchor is held within the needle lumen, the expansion portion 66 between the inner diameter of the needle and T-Tag anchor to generate friction. 在针和T形凸片锚定器之间产生这种摩擦力阻止了锚定器从装置上意外地释放。 Between the needle and T-Tag anchor produce this friction prevents the anchor accidentally released from the device.
在一种示例性实施方式中， 一对T形凸片锚定器在将凸片装载进针的内腔之前是预先打结在一起的。 In one exemplary embodiment, a pair of T-Tag anchor tabs before loading into the lumen of the needle is pre-tied together. 为了将T形凸片锚定器打结在一起，环或其他可滑动的连接构件70,比如在图13中所示的，就会从第一个T形凸片锚定器74上形成在缝线的自由端中。 For the T-Tag anchors knotted together, rings or other slidable connecting member 70, such as shown in Figure 13 in, will be formed from the first T-Tag anchor 74 the free end of the suture. 本领域技术人员可以清楚地意识到环70可以通过各种不同类型 Those skilled in the art may be aware ring 70 by a variety of different types of
13的结形成，比如平结、 一个或多个1/2活结（hitch knots )或绞刑结（hangman's knot)。 Junction 13 is formed, for example square knot, one or more of 1/2 Slipknot (hitch knots) or hanging knot (hangman's knot). 可滑动的连接构件还可以通过替换T形凸片锚定器形成，如图14中所示的，从而缝线62长度的两端都被保持在锚定器内，并且缝线环70从T形凸片中的开口72上凸出以起到连接构件的作用。 Slidable connecting member can also be replaced by the T-Tag anchor is formed, as shown in FIG. 14, so that both ends of the suture length 62 are retained within the anchor, and a suture loop 70 from T Cam opening 72 film projections to function as the connecting member. 而在另一种实施方式中，T形凸片本身可具有让缝线长度84通过的孔。 In yet another embodiment, T-Tag itself may have a length so that the suture 84 through hole. 为了连接锚定器对，连接到第二T形凸片锚定器80内的一端上的缝线84的长度穿过第一T形凸片锚定器74的缝线环70,使得第一T形凸片锚定器能够沿着缝线的长度相对于第二T形凸片锚定器滑动。 To connect the anchor pair is connected to the second T-Tag anchor suture end 80 inside 84 on the length through the first T-Tag anchor suture ring 74 70, so that the first T-Tag anchor along the length of the suture can be relative to the second T-Tag anchor to slide. 在第一T形凸片锚定器74滑动地连接到缝线长度84上之后，结被形成在缝线中。 After the first T-Tag anchor 74 is slidingly connected to the suture length 84, a knot is formed in the suture. 缝线结的作用是在锚定器处于在展开之后的负载下时，将T形凸片锚定器拉到一起并锁定，图13示出了形成在缝线长度84内用于将T形凸片锚定器74， 80拉在一起的单向滑结82。 The role of the suture knot in the anchor after expansion in under load when the T-Tag anchors pulled together and locked, Figure 13 shows the formation in the suture length for the T-84 Tag anchors 74, 80 together pull-way slip knot 82.
在T形凸片锚定器对被展开以后，结82变紧来调整结与第二T形凸片锚定器80之间的距离，同时使得T形凸片锚定器之间的缝线84的对折长度变短。 In the T-Tag anchor pairs is deployed later, 82 knot tightened to adjust the knot and the second T-Tag anchor the distance 80 between the T-shaped projections while allowing the suture anchor between Fold length 84 becomes shorter. 一旦T形凸片锚定器74， 80被展开并固定进组织中，相对于固定的T形凸片锚定器拉动缝线长度84的松弛端86(或缝线93位于第二T形凸片锚定器80近侧的任何部分）会使得对折的缝线长度的尺寸变短直到由于环70的关系它不能进一步变短。 Once T-Tag anchors 74, 80 are expanded and fixed into the tissue, as opposed to fixed T-Tag anchor pulled loose end of the suture length 84, 86 (or 93 stitches in the second T-Tag Any portion of the sheet 80 proximal anchor) would make the size of the folded suture length is shortened due to the relationship between the ring 70 until it can not be further shortened. 随着缝线长度84变短，T形凸片锚定器74, 80被拉在一起。 With suture length 84 becomes shorter, T-Tag anchors 74, 80 are pulled together. T形凸片锚定器74， 80之间的最终距离通过从环70到第一T形凸片74的距离和从结82到第二T形凸片80的距离进行限定。 T-Tag anchor 74, the final distance 80 between the ring 70 by the distance of the first T-Tag and from 74 to 82 to the junction from the second T-Tag 80 are limited. 环70的尺寸可用于调整该总距离。 Size of the ring 70 can be used to adjust the total distance. 另外，环70通过在T形凸片锚定器缝线中打结形成，缝线结82可在连接T形凸片锚定器之前就在缝线长度上预打结。 In addition, the ring 70 through the T-Tag anchor suture knot is formed, the suture knot 82 may be performed before connecting T-Tag anchor in the pre-tied suture length. 在形成了滑结82之后，第一T形凸片锚定器74通过打结形成环70被连接到缝线长度84上。 After the formation of the slip knot 82, first T-Tag anchor 74 is formed by knotting ring 70 is connected to the suture length 84. 第二T形凸片锚定器80通过将末端巻折在锚定器内的方式被连接到缝线长度84的一端上。 The second T-Tag anchor 80 by the end of Volume off in the way the anchor is connected to the end 84 of the suture length. 结82变紧之后，缝线的末端可巻折在T形凸片锚定器80中。 Junction 82 is tightened after the end of the thread can Volume Fold in T-Tag anchor 80. 在图13中所示的滑结82仅仅是适合于将一对T形凸片锚定器连接在一起的结的一个实施例。 In the slip knot 13 shown in FIG. 82 is only suitable for junction pair of T-Tag anchors connected together to one embodiment. 本领域技术人员会意识到可以打成其他类型的滑结，使得一个锚定器可滑动地连接到滑结对折的部分上，同时另一个锚定器被固定到滑结的尾部或自由端，从而在将松开结的作用力仅施加到系统中的锚定器上时会发生单向收紧。 Those skilled in the art will appreciate that other types can be labeled slip knot, so that one anchor is slidably attached to the folded portion of the slip knot, while the other anchor is secured to the rear or free end of the slip knot, It occurs when the force will release the knot so that only applied to the system in the way the anchors tightened.
在T形凸片锚定器打结在一起之后，锚定器对被优选地装载进针的内腔中，从而第一"环形"T形凸片锚定器74初始地展开，接着的是第二"连接，，T形凸片锚定器80,然而顺序是可能互换的。当装载进展开针时，T形凸片彼此相对堆叠，并且每个T 形凸片锚定器都被放在使缝线开口60与针内腔中开槽的开口88 对准的位置。图15A和15B示出了针52的示例性实施例，其中针包括开槽的开口88，其正交于针的轴线延伸。为了将T行凸片锚定器装载进针52中，锚定器向下穿过针内腔的轴线并在内腔远端彼此堆叠。在内腔中，T形凸片锚定器被定位成使得出自每个凸片的缝线退出凸片中部并正交于锚定器的轴线穿过开槽的开口88。开槽的开口88包括侧壁90,其在远离针尖92的方向上在高度上倾斜。侧壁90辅助在针内腔中隐藏和保持T形凸片锚定器， 同时为缝线提供无阻碍出口。其他实施方式可用侧壁90来提供阻止锚定器意外展开的阻力。另外的特征部可合并进侧壁90中来指示凸片。实现这个的一种方法是在特定的预定位置或区域将侧壁90之间的距离变短。当T形凸片74, 80装载进针内腔时，环70 和结82在针52的初级内腔外部延伸穿过开槽的开口88。在一种优选实施方式中，环70和结82被部分或完全地包含在侧壁90之间的开槽的开口88内。在这样的情况下，针52和侧壁90穿透、 切断和/或扩大组织中允许将针平滑引入穿过组织的孔。通过控制切割表面的尺寸，造成的缺陷尺寸可以被最小化。可以理解，通过将针尖92的小部分变尖（用一个或多个倾斜表面），形成的孔是部分通过直接损伤（由针尖92切断）和部分通过扩大造成的（拉扯针52和侧壁90周围的组织）。扩大的范围越大（或可选地切割量越小），针去除之后形成的孔尺寸就越小。这会受组织撕裂所限， 如果扩大得太极端了会出现这种情况。本领域的技术人员可使用这种已知知识使得造成的组织损伤最小化。通过用侧壁90来部分或完全地隐藏环70和结82,实现了对造成孔尺寸更大的控制和实现更平滑的引入。 After the T-Tag anchors tied together, the anchor pair is preferably loaded into the lumen of the needle, so that the first "ring" T-Tag anchor 74 is initially launched, followed by the The second "connection ,, T-Tag anchor 80, but the order is likely interchangeable. When loading progress open pin, T-shaped tabs stacked opposite each other, and each T-Tag anchors are on the suture 60 and needle lumen opening 88 slotted openings aligned position. Figures 15A and 15B illustrate an exemplary embodiment of the needle 52, wherein the needle includes a slotted opening 88, which is orthogonal to the pin axis. In order to T-line anchor tabs loaded into needle 52, anchor down through the axis of the needle lumen and the distal end of the inner chamber stacked upon each other. inner cavity, T-shaped tabs the anchor is positioned so that the suture from each tab of the exit and orthogonal to the central lug anchor axis through the opening 88 slotted opening 88. The side wall 90 includes a slot, away from its tip 92 is tilted in height sidewalls 90 auxiliary hiding and holding T-Tag anchors within the needle lumen, as well as sutures provide unhindered export. Other embodiments can be used to prevent the side walls 90 to provide an anchor accidental expand resistance. Additional features may be incorporated into the side wall 90 to indicate tabs. One way to achieve this is in a particular location or area predetermined distance 90 between the sidewall becomes shorter. When the T-shaped opening tabs 74, 80 is loaded into the needle lumen, the ring 70 and end in the primary lumen 82 extends through the slot outside of the needle 52 88. In a preferred embodiment, the ring 70 and knot 82 are partially or completely contained within the slotted wall 90 between the opening 88. In this case, the needle 52 and side walls 90 penetration, cutting and / or expand the organization to allow the smooth introduction of the needle through the tissue of the hole. By controlling the size of the cutting surface, resulting in defect size can be minimized. It will be appreciated by a small portion of the sharpened needle tip 92 (with one or more inclined surfaces), the hole is formed in part by direct injury (by the tip 92 cut) and some surrounding tissue 90 by (pull pin 52 and the side walls expand due). expanded range greater (or alternatively cut smaller amount), the smaller the pore size formed after needles removed. This by tissue tearing limit, if expanded too extreme will happen skilled in the art may use this knowledge makes known cause tissue damage is minimized by using sidewall 90 partially or completely hide ring 70 and junction 82, causing the pore size to achieve a greater control and a smoother introduction.
除了在图15A至15B中所示的开槽的针之外，各种不同的其他类型的组织穿刺装置可以被用来在本发明中展开T形凸片锚定器，图16和17示出了可选实施方式，其中扩张针76被用来与钉仓32 —起穿透组织和展开T形凸片锚定器。 In addition to the slotted shown in FIGS. 15A to 15B needle, a variety of other types of tissue penetrating devices may be used to expand the T-Tag anchors in the present invention, shown in Fig. 16 and 17 an alternative embodiment in which the expansion of the needle 76 is used in conjunction with the magazine 32-- from penetrating tissue and deploy T-Tag anchor. 所述针的优点是在组织中造成的孔的尺寸会进一步最小化。 The advantage is the size of the needle hole in the organization caused further minimized. 在该实施方式中，针76包含一对向内偏置的、平行的、隔开的臂部77， 78,其共同融合成针远端上锋利的尖端。 In this embodiment, the pin 76 includes a pair of inwardly biased, parallel, spaced apart arms 77, 78, the co-integration into the tip of a sharp needle distal end. T形凸片锚定器可被装载进在臂部77, 78 之间形成的内腔中，并且通过向内偏置的臂部77, 78保持在该内腔中。 T-Tag anchors may be loaded into the arm 77, 78 is formed between the lumen, and through the arm portion 77 inwardly biased, 78 held in the lumen. 当将T形凸片锚定器装载进针内时，缝线环70和连接到T 形凸片上的结82从臂部之间的侧开口突出。 When inside the T-Tag anchors loaded into the needle, the suture ring 70 and the opening 82 is connected to the junction between the arm protruding from the side of the T-shaped tabs on. 为了穿透组织，臂部77， 78尖锐的远端在封闭尖端处被保持在一起。 To penetrate tissue, the arm 77, 78 in a closed sharp tip at the distal end are held together. 穿透组织之后， 通过向T形凸片锚定器叠层的近端施加作用力而使T形凸片向远侧前进，由此展开T形凸片锚定器。 After penetrating tissue, through the T-Tag anchor stack proximal force is applied leaving the T-Tag distally advance, thus giving T-Tag anchor. 由于T形凸片锚定器向远侧移动，T形凸片的作用力分离了远侧尖端处的臂77， 78,如图17 所示，从而使得T形凸片能够穿过尖端并在针的外面。 Since the T-Tag anchors move distally, T-shaped lug force separation at the distal tip of the arm 77, 78, 17, so that the T-shaped lug to pass through the tip and outside of the needle. 在图18A 至18C中示出了可能的组织穿刺装置的一些另外的实施方式。 In FIGS. 18A to 18C are shown some further embodiments of possible tissue penetrating devices. 在图18A至18C中所示的每个装置包括一至少部分磨尖的尖端用来刺穿组织，还有开槽的内腔。 In each of the devices shown in FIG 18A to 18C includes an at least partially sharpened tip for penetrating tissue, as well as a slotted lumen. 装置中开槽的内腔至少部分地保持了T形凸片锚定器，与此同时使得连接到锚定器上的缝线能够延伸到装置外面。 Means slotted lumen at least partially retains the T-Tag anchor, such that at the same time be connected to the suture anchor can be extended to the outside devices.
可选的紧固件设计也与本文含有的钉仓和装置实施方式相兼容。 Optional fastener design is also compatible with the cartridge and device embodiments contained herein. 一个这样的实施例包含两个由不可回弹的柔性材料比如缝线连接起来的T形凸片。 One such embodiment includes two by a non-resilient flexible material such as suture connecting the T-shaped lug. 在这个相关的实施方式中， 一股缝线被安全地连接到组织锚定器上。 In this related embodiment, the surge of suture is securely attached to the tissue anchor. 该股缝线可滑动地连接到第二组织锚定器上。 Stock suture is slidably connected to the second tissue anchor. 与第二锚定器可滑动的连接使得锚定器仅能够在缝线朝向第一锚定器的方向上滑动。 And second anchor is slidably connected so that only the anchor to slide toward the first suture anchor direction. 实现这种单向滑动特征的特征部可以被包含在缝线或第二锚定器中。 To achieve this unidirectional sliding feature may be contained in the feature portion of the suture or the second anchor in. 带毛刺的缝线的使用是明显能满足该目的的一个实例。 The use of barbed suture is clearly an instance to meet this purpose. 然而，在第二组织锚定器本身中或其上使用单向锁定部也可以达到该目的。 However, in the second tissue anchor itself or a one-way locking portion can also achieve this purpose. 众多单向锁定部机构是本领域技术人员公知的并且无需对在此介绍过的展开组织锚定器的钉仓或装置进行重大改变就能够应用于这种情况。 Many one-way locking mechanism unit is known to a person skilled in the art and do not need to expand the tissue anchors of the cartridge or device presented here had significant changes can be applied to this case. 众多组织锚定器也与本发明相一致。 Many tissue anchors are also consistent with the present invention. 适用于该任务的组织锚定器和紧固件的实例 Examples of suitable to the task of tissue anchors and fasteners
包括但不限于T型锚定器（上面提到过并在下面更详细地介绍）、 Including but not limited to T-type anchors (mentioned above and described in more detail below).
可重置的"筐"型锚定器（其通常包含许多在两个卡箍或支撑构件之间延伸的可设置的支柱或支脚）以及线性锚定器（构造成折叠或压缩成像弓一样弯曲的或膨胀的构造的细长的锚定器）。 Reconfigurable "basket" -type anchors (which generally comprise a number of between two clamps or support member may be provided extending pillars or legs), and linear anchors (configured to fold or bend their bow compression imaging or expanded configuration of elongate anchors). 通常地，锚定器的特征在于，在展开前它们可以被容易地放进或通过组织，而展开后具有变化的构造，该变换的构造提供至少一个足够大的尺寸以将锚定器保持在适当位置。 Typically, the anchor is characterized in that, before the commencement of them can be easily put into or through the organization, and has a configuration change after the commencement of construction of the transformation of at least a large enough size to be kept at anchor position.
现在回到图7到11，在钉仓32的第一种实施方式中，与第一T形凸片74滑动连接的缝线84的对折长度被保持在钉仓内缝线环腔94中。 Returning now to FIG. 7-11, in the first embodiment of the cartridge 32, and the first T-Tag suture 74 slidably connected to the fold length 84 is maintained within the cartridge chamber 94 of the suture ring. 缝线在结82和自由缝线端86之间的另外的部分（其由图11中的附图标记93标识出）在缝线腔94中被分开保留。 Between the node 82 and the free end 86 of the suture portion of the suture further (marked by the reference 93 in FIG. 11 identified) in the suture retention chamber 94 are separated. 保留的缝线长度在缝线腔边界内分开地环绕它们自身。 Length of the suture retention surround themselves within suture cavity boundary separately. 缝线部93部分从缝线腔94向近侧延伸。 Portion of the thread portion 93 extends proximally from the suture cavity 94. 如图IO中所示，在腔94的近端，缝线部93横跨钉仓中的开放通道34。 As shown in FIG IO, the proximal end portion of the suture cavity 94 in the cartridge 93 across open channel 34. 用附图标记96标识的裂缝（或楔块）形成在通道34的相对边上，用来将缝线保持在横贯通道的适当位置。 Cracks 96 identified (or wedges) formed by the reference numeral 34 in opposite sides of the channel for holding the suture in place across the channel. 缝线的自由端86从通道34向远侧穿过终点凹槽102。 The free end of the suture 86 from channel 34 through the groove 102 to the distal end. 终点凹槽102具有初始的、狭窄半径的片段104,该片段打开沿着凹槽位于远端间隔位置处进入的更宽直径范围106。 End recess 102 has an initial, narrow radius segments 104, which segments open along the grooves into the gap located at the distal end 106 of the wider range of diameters. 缝线末端 Suture end
86延伸通过终点凹槽的狭窄片段104并穿过进入更宽直径范围106中的开口。 The end of the recess 86 extends through the narrow segment 104 and enters a wider range of diameters through the opening 106. 结、巻折或其他尺寸增强元件110被放置在缝线的自由端，并且巻折放进了终点凹槽的更大区域106中。 Knot, Volume discount or other size enhancing member 110 is placed at the free end of the suture, and folded into a larger area of Volume 106 of the terminal groove. 缝线扩大的末端110将缝线锁定在终点凹槽102内的适当位置，阻止了当缝线在收紧T形凸片锚定器的过程中处于负载下时缝线末端通过凹槽向近侧移动。 Expand the suture end 110 suture locking groove 102 in the end position, it prevents the suture is under load when tightening T-Tag anchor in the process by the end of the groove when the suture to close mobile side. 当上述的第一种钉仓联接方法用来将钉仓32 连接到紧固件展开装置20时，终点凹槽102恰好位于第二凹槽36的近侧。 When said first cartridge coupling method is used to connect the cartridge 32 to fastener deploying device 20, terminal groove 102 located just proximal of second groove 36.
如图7和11所示，切割装置可配备在装置20中用来切断缝线。 As shown in Fig. 7 and 11, the cutting device 20 can be equipped in the apparatus for cutting sutures. 切割装置可包含位于钉仓32远端上的切割构件112。 Cutting device may comprise a cutting member located on the distal end of cartridge 32 112. 优选地， 切割构件112是内嵌模造在钉仓32的主体中，但是也可通过其他装置连接。 Preferably, the cutting member 112 is embedded in the molding of the cartridge body 32, but may be connected by other means. 磨尖的刃120通过V形凹口122与切割构件剩余的主体分隔开。 Sharpened edge 120 by a V-shaped notch 122 and the remainder of the cutting member body separated. 刃120设计成使得缝线能够缠绕在切割构件周围并穿过凹口122。 Blade 120 is designed so that the suture can be wound around the cutting member 122 and through the recess. 随着紧固件的展开和在展开的T形凸片锚定器之间的缝线的收紧，剩余缝线长度可穿过凹口122绕成圏。 With the fastener deployment and in the deployed T-Tag anchor suture to tighten the set between the remaining length of the suture can be passed through the notches 122 wound Juan. 抓紧器可用来辅助将缝线拉进凹口122。 Grasper can be used to assist the suture pull into the recess 122. 如果缝线在凹口122内，可用稳定的运动向近侧拉钉仓32，以便将缝线朝着刀片120张紧进而切断缝线。 If the suture within the recess 122, in stable motion cartridge 32 pulled proximally to tension the suture towards the blade 120 and then cut the suture. 切割构件122是可以与本发明的钉仓一起使用的缝线切割装置的一个实例。 Cutting member 122 is one example of a suture cutting means of the present invention, the cartridge can be used together. 本领域技术人员已知的其他可选装置和方法也可以用来在收紧T形凸片锚定器之后切断缝线，这不脱离本发明的范围。 Other alternative devices and methods known to those skilled in the art can also be used after the tightening of the T-Tag anchor suture cutting, without departing from the scope of this invention.
现在转到图19和20，其详细地示出了第一示例性紧固件展开装置20。 Turning now to FIG. 19 and 20, which shows in detail a first exemplary fastener deploying device 20. 如上所述，展开装置20包括手柄22和细长的管状壳体30,该管状壳体从手柄在远侧方向上向外延伸。 As mentioned above, deploying device 20 includes a handle 22 and an elongated tubular housing 30, the tubular housing extends outwardly from the handle in a distal direction. 手柄22优选地包含模塑的塑料外套，其具有形成在其中的通道126,壳体30 可以相对于手柄滑动通过该通道126。 Handle 22 preferably comprises a molded plastic housing having a passage 126 formed therein, with respect to the handle housing 30 can slide through the channel 126. 壳体30包括用来联接钉仓32的开放远端。 Housing 30 includes means for coupling the distal end of the cartridge 32 is open. 如上所述，壳体30的远端可以包括凸起部40、 As described above, the distal end of the housing 30 may include a protrusion 40,
18"L"形切口50,或其他用于将钉仓联接到壳体上的相关连接装置中的任一种。 18 "L" shaped cutout 50, or other means for coupling a cartridge to the associated connecting device housing on any one. 具有连接按钮132的柱杆130垂直于壳体的轴线延伸并通过手柄的外套，其用来手动地缩回和/或推进壳体。 Column has a connection button 132 of the rod 130 extends perpendicular to the axis of the housing and through the handle of the jacket, which is used to manually retracting and / or advancing the housing. 柱杆130 依附在形成于手柄外套中的轨道134。 Pole 130 attached to the handle housing formed in the track 134. 为了缩回（或推进）壳体30,按钮132被向下推压而使柱杆130乂人轨道134末端处的两个凹形区中的一个上脱离。 To retract (or advance) housing 30, the button 132 is pushed down from the mast leaving two recessed area 130 Yi in person at the end of the track 134 on one. 一旦脱离，柱杆130可手动地通过轨道134滑动到轨道的相对端的凹形区。 Once out, the mast 130 may be manually slid through the track 134 to track the opposite end of the recessed area. 在凹形区，柱杆130和按4丑132在弹簧136的力的作用下向上弹起。 In the recessed area, post 130 and 132 by 4 ugly under the force of the spring 136 upward bounce. 轨道凹形将柱杆130和对应的连接壳体30锁定在适当位置并阻止了进一步的移动。 The mast track female connector 130 and the corresponding housing 30 locked in place and prevents further movement. 通过压下按钮132，柱杆130可通过轨道134前后移动从而推进或缩回壳体。 By depressing button 132, post 130 can be moved so as to advance or retract the casing 134 through the front and rear tracks. 在轨道的每一端，弹簧加载的柱杆向上弹起进入凹形从而将柱杆和壳体锁定在适当位置。 At each end of the track, the spring-loaded pop-up the mast so that the mast into the female housing and locked in place.
如图20和21中更详细所示，手柄22包括用来将T形凸片锚定器从连接钉仓的针上弹出的致动机构。 20 and 21 in more detail, the handle 22 includes a T-shaped tabs are used to anchor the pop-up cartridge from the connector pin actuating mechanism. 致动机构包括细长的推杆140,其从手柄22纵向延伸通过壳体30。 Actuating mechanism includes an elongated push rod 140 which extends longitudinally from handle 22 through the housing 30. 推杆140被封进圆柱形的、纵向延伸的推杆护套142中。 Push rod 140 is sealed into the cylindrical, longitudinally extending push rod sheath 142. 销146通过推杆护套142的近端用来将护套连接到手柄外套上。 Pin 146 through the proximal end of push rod sheath 142 is connected to the sheath to the handle casing. 推杆护套142的远端延伸到壳体30的远端并且设计成当钉仓连接到壳体上时与针52的近端相匹配。 The distal end of push rod sheath 142 extends to the distal end of the housing 30 and is designed so that the proximal end 52 of the needle matches the cartridge is connected to the housing. 图22详细地示出了钉仓32的近端。 Figure 22 shows in detail a proximal end 32 of the cartridge. 如此图中所示，针52在管状腔144内滑动通过钉仓32的内部。 As shown in this figure, the needle 52 within the tubular chamber 144 by sliding the cartridge 32 inside. 腔144在钉仓的近端和远端都是开放的。 144 in the cartridge chamber of the proximal and distal ends are open. 针52的近端包括凹口150,当针全部^皮封进钉仓中时该凹口靠近针腔144的近端。 The proximal end of needle 52 includes a notch 150, when the needle all the ^ skin closure when the cartridge into the recess near the proximal end of the needle chamber 144. 当钉仓32与壳体30相匹配时，钉仓近端被插入到壳体的远端中。 When the cartridge 32 and the housing 30 matches, the cartridge is inserted into the proximal to the distal end of the housing. 由于钉仓被插入到壳体中，推杆护套142近端上的凸片152被插入到针腔144的顶部。 Because the cartridge is inserted into the casing, the tabs 142 on the proximal end of push rod sheath 152 is inserted into the top of the cavity 144 of the needle. 当钉仓相对于壳体旋转以便将钉仓锁定到壳体上时，推杆护套142 的远端从针腔144顶部向下旋转从而使凸片15与针凹口150匹配接触。 When the cartridge rotation relative to the housing to lock the cartridge to the housing, push rod distal end of sheath 142 is rotated downward from the top of the needle chamber 144 so that the tabs 15 into contact with the needle notch 150 match. 由于推杆护套142被旋转成与针52相接触，凸片152在凹口150中接合到位以便将推杆护套连接到针上。 Since the push rod sheath 142 is rotated into contact with needle 52, tab 152 engages a notch 150 in place in order to connect the push rod sheath to the needle. 如果推杆护套142 If the push rod sheath 142
19与针52相匹配，推杆140的远端就会与针内腔中的T形凸片锚定 19 matches with the needle 52, the distal end of the push rod 140 and the needle lumen will be a T-Tag anchor
器叠层的近端轴向对准，用来将锚定器从针上推进或弹出。 The proximal end of the axially aligned stacks, used to anchor the propulsion or ejected from the needle. 如上 Above
所述，针腔144在钉仓32的远端开放从而使得针能够从钉仓上向远侧暴露出来。 The needle chamber 144 is open at the distal end of the cartridge 32 so that the needle can be exposed distally from the cartridge.
如图23中所示，推杆140的近端安装在手柄22内部的推杆驱动器154中。 Shown in Figure 23, the proximal end of the push rod 140 is mounted inside the handle 22 of the push rod driver 154. 推杆驱动器154在通过扳机26启动时就会将推杆140向远侧推进预定的距离。 Push rod driver 154 through the trigger 26 will start the push rod 140 is advanced distally a predetermined distance. 推杆推进才几构在扭j几26和推杆驱动器154之间延伸，其用来将扳机上的手动挤压运动转换成推杆140 朝着T形凸片锚定器的向前的推进力。 Fader configuration in advance only a few twisted j 154 extends between 26 and putting a few drives, which are used to manually trigger movement into a squeeze on the push rod 140 toward the T-Tag anchors forward propulsion force. 推杆推进机构包括驱动爪160,其通过连杆162连接到扳机26上。 Push rod advancing mechanism includes a drive pawl 160, which is connected to the trigger 26 through a connecting rod 162. 驱动爪160在连杆中绕第一销168枢转。 Drive pawl 160 to pivot about the first pin 168 in the connecting rod. 锁键170位于驱动爪160的远端上。 Lock key drive pawl 170 is located on the distal end 160. 扭转弹簧161绕第一销168放置并且将锁键170偏置到与推杆驱动器154 接触。 Torsion spring 161 is placed around the first pin 168 and the latch 170 will be biased into contact with push rod driver 154. 第二销166在驱动爪160的两侧壁之间延伸。 The second pin 166 between the side walls of the drive pawl 160 extends. 推杆驱动器154包括多个向下指向的齿172，如图24中所示。 Push rod driver 154 includes a plurality of downwardly directed teeth 172, shown in Figure 24. 当扳机26处于打开位置时，推杆驱动器齿172设置在驱动爪锁键170的远侧， 使得向上延伸的锁键每次与一个齿啮合以向远侧推进推杆。 When the trigger 26 is in the open position, the push rod driver teeth 172 disposed on a distal drive pawl catch 170 so that the lock button and an upwardly extending teeth meshing with each distally advance putter. 驱动爪弹簧174被连接在连杆162内的手枪式握4巴24销176和杠杆178之间，以便将驱动爪160向近侧方向偏置。 Drive pawl spring 174 is connected to the link 162 in pistol grip 4 bar 24 between the pin 176 and the lever 178 to bias the drive pawl 160 in the proximal direction. 棒192通过一对销被连接到杠杆178和扳机26之间，以便将扳机上的挤压运动转换成在连杆162内的枢转运动。 Rod 192 by a pair of pins 178 and is connected to the trigger lever 26 between, in order to squeeze the trigger movement into a pivotal movement of the link 162. 如图23和24中所示，推杆驱动器弹簧180位于推杆驱动器154的远端用来将驱动器向近侧偏压到与驱动爪160接触。 As shown in FIG. 23 and 24, the push rod driver spring 180 located at the distal end of the pusher drive 154 is used to drive proximally bias pawl 160 into contact with the drive. 止回爪182位于驱动爪160的远侧以便在每次向前的T形凸片展开推进之后与推杆驱动器齿172啮合，从而阻止推杆驱动器在完成锚定器的展开前缩回壳体30内。 After backstop claw 182 is located distal to drive pawl 160 forward in each T-Tag expand promote and push rod drive gear 172 meshed, thereby preventing the plunger drive before completing the expansion anchor retracted housing 30.. 止回爪182包括锁一建184,其具有近侧倾斜边和远侧截止边。 Backup pawl 182 includes a built in lock 184, having a proximal edge and a distal inclined cutoff edges. 止回爪锁键: 184的尺寸定成能够使锁键沿着截止边的表面啮合齿172并安全地将齿172保持在推杆驱动器154上。 Backstop claw lock key: 184 dimensioned to be able to make the catch along the surface of the cut-off edge of tooth 172 and the tooth 172 securely held on the push rod driver 154. 止回爪182绕销186枢转以与推杆驱动器154进入接触和脱离接触。 Anti-backup pawl 182 to pivot about the pin 186 and push rod driver 154 is brought into contact and out of contact. 当止回爪182没有接触到推杆驱动器154时，止回爪弹簧190在向上的方向上将止回爪182偏压到与推杆驱动器154啮合，但还不够与推杆驱动器弹簧180接触。 When the anti-backup pawl 182 does not come into contact with push rod driver 154, preventing claw spring 190 in the upward direction will backstop claw 182 engaged with the push rod 154 is biased to drive, but not enough contact with the push rod driver spring 180.
如图19和20中所示，缝线收紧组件被封进壳体30内用来将展开的T形凸片锚定器在组织内彼此相邻放置。 19 and 20, the suture cinching assembly is used to expand the seal into the housing 30 of the T-Tag anchors are placed adjacent to each other within the organization. 如图25中更详细地所示，缝线收紧组件包括缝线抓紧构件200,其在壳体30内轴向延伸。 25 in more detail, the suture cinching assembly includes a suture grasping member 200, which extends axially within the housing 30. 缝线抓紧构件200的远端是弯曲的并且向近侧折回从而形成具有倾斜远侧尖端的钩202。 The distal end of suture grasping member 200 is bent and folded back proximally to form a hook 202 having an inclined distal tip. 圆柱形的开槽引导构件206位于壳体30内部靠近远端处并且在壳体30内被固定到位。 Cylindrical slotted guide member 206 is located near the distal end of the inner casing 30 and the housing 30 is secured in place. 缝线抓紧构件200传过引导构件206中的槽，以便指引缝线抓紧构件200 的远端运动进入连接的钉仓近端。 Suture grasping member 200 pass through the slot in the guide member 206 to guide movement of the distal end of the suture grasping member 200 into the cartridge end of the connection. 缝线抓紧构件200近端被连接到圆柱形滑梭204上。 Suture grasping member 200 is attached to the proximal end of the cylindrical shuttle 204. 缝线抓紧构件200向构件的轴弯折一定角度以便与滑梭204中的开口接合。 Suture grasping member 200 is bent at an angle to the shaft member 204 to engage the shuttle in the opening. 引导构件206和滑梭204都包括能让推杆护套142 (和封起的推杆）穿过其中到达壳体30的远端的通孔。 The guide member 206 and shuttle 204 includes a sheath 142 allow push rod (and sealed from the ram) therethrough reaches the distal end of the housing 30 through hole.
收紧弹簧210从滑梭204上大致向近侧延伸穿过壳体30的长度。 Cinching spring 210 extends proximally through approximately length of the housing 30 from the shuttle 204. 收紧弹簧210是可压缩的，用来将缝线抓紧构件200和滑梭204向近侧缩回进壳体中。 Cinching spring 210 is compressible, used to suture grasping member 200 and the shuttle 204 is retracted proximally into the housing. 如图19和20中所示，收紧弹簧210 包含多个由圆柱形连接片208结合在一起的弹簧片段。 19 and 20, the tightening spring 210 comprises a plurality of cylindrical connecting piece 208 by a spring clip together. 每个连接片208具有能够让推杆护套142和拉杆212延伸通过收紧弹簧内部的一对通孔。 Each connection piece 208 enables the push rod sheath 142 having a rod 212 and a pair of through holes extending through the interior of the tightening spring. 拉杆212被连接到滑梭204的远端上。 Rod 212 is connected to the distal end of the shuttle 204. 拉杆212 从滑梭204上延伸通过收紧弹簧210 (在壳体30中）和手柄通道126。 Rod 212 extending from the shuttle 204 by tightening the spring 210 (housing 30 in) and handle channel 126. 拉杆212的近端通过销214连接到手柄22外部上的旋钮216 上。 The proximal end of the rod 212 is connected to the knob 216 on the exterior of the handle 22 by a pin 214. 旋钮216又提供了在缝线收紧过程中用来手动缩回滑梭204 和缝线抓紧构件200的机构。 Dial 216 and provide a mechanism to tighten the process for manually retracted the suture shuttle 204 and suture grasping member 200. 作为拉杆212和旋钮216的替代方式，本领域技术人员已知的其他装置可用来在壳体内向近侧缩回缝线抓紧构件200。 As an alternative to pull rod 212 and knob 216, other devices known to a person skilled in the art can be used to retracting suture grasping member 200 proximally within the housing. 这些可选装置其中可以包括杠杆，细绳和滑轮。 These optional devices which can include levers, strings and pulleys. 图26示出了在紧固件展开之前的展开装置20和连接的钉仓32。 Figure 26 shows the fastener deploying before deploying device 20 and connected cartridge 32. 为了从针52上展开第一T形凸片锚定器，手柄22上的按钮132被压下并且通过轨道134向近侧滑动以〗更缩回壳体和连接的钉仓。 For the first T-Tag anchor, button 22 on the handle 132 is depressed and slid proximally through track 134 from the needle 52 expands to retract the〗 more housing and attached cartridge. 壳体30缩回时，壳体通过手柄中的通道126滑动。 When the housing 30 is retracted, the housing slides through channel 126 in the handle. 连接的钉仓32与壳体30—起缩回，将针52从钉仓的远端暴露出来，如图27中所示。 Cartridge 32 from the housing connected to the 30- to retract the needle 52 is exposed from the distal end of the cartridge, as shown in FIG. 27. 钉仓32缩回时针52保持静止，这是由于针和静止的推杆护套142之间的连接。 Cartridge 32 is retracted hour 52 remains stationary, this is due to the push rod sheath 142 is connected between the pin and the stationary. 当钉仓32缩回时，缝线抓紧构件200在壳体30内保持原位，这导致了当钉仓绕抓紧构件缩回时， 抓紧构件会被推进到钉仓的开放通道34中。 When the cartridge 32 is retracted, the suture grasping member 200 remain in place in the housing 30, which led to around grasping member when the cartridge is retracted, the gripping member is pushed into the cartridge open channel 34. 当钉仓32绕缝线抓紧构件200缩回时，横跨通道34的缝线片段93被元件的倾斜尖拉到缝线抓紧构件的钩202下面并进入其中。 When the cartridge 32 retracts about suture grasping member 200, the cross channel 34 of the suture 93 is pulled fragment suture grasping member 202 following the inclination of the hook element and into which the tip. 另外，钉仓32缩回时，推杆140 (其保持静止）从壳体30的远端通过推杆护套142 和针52之间的匹配连接推进到针内腔的近端中。 In addition, when the cartridge 32 is retracted, the push rod 140 (which remains stationary) matching push rod sheath 142 and the needle 52 to advance to the connection between the proximal end of the needle lumen from the distal end of the housing 30 to pass through. 推杆140远端上圓形的、锥形的或其他倾斜边缘可用来帮助推杆进入针52的内腔中。 The distal end of the pusher 140 round, tapered or other sloping edge can be used to help push rod into the cavity 52 of the needle.
针52在钉仓的远端暴露，手柄22被手动地向前推到用针尖92穿透靶组织区。 Needle 52 at the distal end of the cartridge is exposed, the handle 22 is manually pushed forward to 92 with a needle to penetrate the target tissue area. 针52在组织内部并通过组织，4反机26 4皮手动地在手枪式握把24的方向上挤压。 Needle 52 within the organization and through the organization, four anti-aircraft 264 leather manually in the direction of pistol grip 24 of the extrusion. 扳机保险194位于扳机26顶部附近。 Insurance trigger trigger 194 located near the top 26. 扳机保险194在扳机26之前被手动挤压并且之后随着扳机26—起被手动地挤压，以便使扳机旋转。 Insurance trigger 194 before the trigger 26 is manually squeezed and thereafter starting with 26- trigger is manually squeezed so that the rotation of the trigger. 当4反机26朝着手枪式握把24旋转时，连杆162绕销164枢转从而向远侧方向推动驱动爪160。 When the 4 anti-aircraft 26 toward the pistol grip 24 rotates, link 162 to pivot about the pin 164 to drive the drive pawl 160 in a distal direction. 初始地，驱动爪160是位于形成在手柄外套内的驱动爪轨道220内的最近侧位置。 Initially, drive pawl 160 is located proximal jacket formed within the handle 220 of drive pawl track. 驱动爪160与推杆驱动器154上的远侧齿接合，其依次位于推杆驱动器轨道218末端的最近侧位置上。 Drive pawl 160 and the distal tooth on push rod driver 154 engages pushrod driver which in turn is located in the end of the track 218 on the proximal-most position. 当扳机26被挤压时，如图28中所示，驱动爪160会沿着轨道220被推向远侧。 When the trigger 26 is squeezed, as shown in the figure, the drive pawl 160 is advanced distally along track 220 28. 当驱动爪160被推向远侧时，驱动爪向远侧的推杆驱动器齿施加压力以便以同样的方式使驱动器通过轨道218被推向远侧。 When the drive pawl 160 is advanced distally, the drive pawl distally putting pressure on the teeth in order to drive in the same way that the drive is pushed distally through track 218. 为了推进推杆驱动器154，需要通过扳机26施加足够的作用力来克服推杆偏置弹簧180的反作用力。 To advance push rod driver 154 to overcome the reaction force of the push rod biasing spring 180 needs to exert sufficient force by the trigger 26. 如上所述， As described above,
推杆140的近端连接到推杆驱动器154上。 The proximal end of the pusher 140 is connected to the push rod driver 154. 因此，当推杆驱动器154由驱动爪160推向远侧时，推杆140会在针52的内腔里以同样的方式被推向远侧。 Thus, when the push rod driver 154 distally by a drive pawl 160 toward the pusher 140 in the lumen of the needle 52 in the same manner is pushed distally. 当推杆140推进时，推杆与针内腔里的T 形凸片锚定器叠层的近端接触。 When the rod 140 forward, the plunger and the needle lumen in the T-Tag anchor stack contacts the proximal end. 当推杆140进一步推进时，推杆140与T形凸片锚定器叠层的接触作用力使T形凸片锚定器叠层向着针的开放远端滑动。 When the rod 140 to further advance the plunger 140 and the T-Tag anchor stack to make contact force T-Tag anchor stack towards the open distal end of the needle slide. 推进推杆140的作用力将叠层中最远侧的T形凸片锚定器（也就是第一T形凸片锚定器74)从针中弹出进入或通过组织。 Advancing forces push rod 140 will stack the distal-most T-Tag anchor (that is the first T-Tag anchor 74) from the needle popped into or through the tissue. 当T形凸片锚定器展开时，连接到T形凸片上的缝线结或环70通过槽88穿出针。 When the T-Tag anchor is deployed, the suture knot to connect to the T-shaped lug or ring 70 through slots 88 piercing needle. 注意推杆的总行程大于在扳机第一次挤压过程中一个T形凸片的长度，如图27和28中所示。 Note that putting stroke is greater than the total in the first extrusion process trigger a T-shaped lug length, as shown in FIG. 27 and 28. 当推杆140将第一T形凸片锚定器74推出针52时，驱动爪160推动推杆驱动器154的远侧齿通过止回爪182的锁键。 When the push rod 140 of the first T-Tag anchor 74 Release pin 52, drive pawl 160 push rod driver 154 distally through the backstop tooth pawl catch 182. 止回爪锁键184倾斜的近侧边使得止回爪能够围绕销186向下偏离， 通过远侧的推杆驱动器齿的斜面，从而使得远侧齿172能够通过止回爪锁键184。 Anti-backup pawl catch 184 is inclined so that the side near the non-return pawl about pin 186 can deviate downward by the inclined surface of the distal push rod driver tooth, such that the distal tooth 172 through anti-backup pawl catch 184. 在远侧齿172推过止回爪锁4建184的倾斜面之后，止回爪182由于弹簧190的弹力而弹回到与推杆驱动器154 的下表面接触，如图29中所示。 After the distal tooth 172 are pushed through the non-return pawl lock 4 built inclined surfaces 184, 182 due to the anti-backup pawl spring 190 and the force of spring back into contact with the lower surface of the push rod driver 154, shown in Figure 29. 在第一T形凸片锚定器从针52 上展开并且止回爪182与推杆驱动器154的第一远侧齿接合之后， T形凸片已展开的触觉反馈可提供给外科医生。 In the first T-Tag anchor is deployed from needle 52 and backstop claw 182 after the first distal push rod driver tooth 154 engages, T-Tag has been deployed to provide tactile feedback to the surgeon. 该触觉反馈可以通过许多种不同方式提供。 The haptic feedback may be provided by a variety of different ways. 在图28和29中所示的实施方式中， 反馈通过手柄22内的弹簧加载按钮222提供。 In the embodiment shown in FIG. 28 and 29, the feedback button 222 by a spring-loaded handle 22 is provided. 按钮222位于形成在手柄外套中的凹窝内。 Button 222 located in the handle casing is formed dimples within. 按钮222位于凹窝内从而使得按钮的一端突出进入枢转扳机26的通路中。 One end of the button so that the button 222 is located within the recess projecting into the pivot path 26 of the trigger. 当扳机26靠近其冲程末端， 扳机的边缘接触到按钮222的末端，如图28中所示。 When the trigger 26 near the end of its stroke, an edge of the trigger contacts the end of button 222, as shown in FIG. 28. 在接触到按钮222之后继续旋转扳机26会产生额外的手动阻力，这是由于扳机必须克服反馈按钮弹簧224的反作用力工作。 After contact with the button 222 will continue to rotate trigger 26 produces additional manual resistance, which is due to the trigger must work against the reaction force feedback button spring 224.. 优选地，按钮弹簧224具有高的压缩力因此要压缩弹簧的话就需要显著的增加手动挤压的压力。 Preferably, button spring 224 has a high compressive strength and therefore the compression spring, then you need a significant increase in manual squeezing pressure. 按钮弹簧224反作用阻力通过扳机26被使用者感受到，从而为使用者提供了到达沖程末端的提示。 Button 224 spring reaction resistance felt by the user through trigger 26, and thus provides the user reaches the stroke end tips. 在一种替代实施方式中，扳机片段接触到销，当在抵触位置时其不允许扳机前进通过将会接触到弹簧加载按钮222的点。 In an alternative embodiment, the trigger fragment thereof to the pin, when conflict does not allow the trigger forward its position by the spring-loaded button will be exposed to 222 points. 然而该销可以通过手动去除并且可以移动到不抵触的位置上，如果需要的话还允许扳机进一步的前进。 However, the pin can be removed by hand and can be moved to a position on the subject, if necessary trigger also allows for further progress.
当接收到触觉反馈时，或否则扳机沖程完成时，在扳机26上的手动压力被释放了，从而允许扳机在位于扳机连杆162中的驱动爪弹簧174的作用下枢转回其初始位置。 Upon receiving the tactile feedback, or otherwise trigger stroke when completed, the manual pressure on the trigger 26 is released, allowing the trigger in the trigger rod 162 is located in the drive pawl pivot under the action of the spring 174 back to its initial position. 当扳机26旋转远离手枪式握把24时，驱动爪160沿着推杆驱动器154的下边缘向近侧被驱动回到轨道220的近端。 When the trigger 26 rotates away from pistol grip 24, the drive pawl 160 along the lower edge of the push rod driver 154 to be driven back to the proximal end of the track 220 proximally. 第二推杆驱动器齿172的远侧斜面使得驱动爪能够越过并超过第二齿到达轨道220的近端。 A second push rod driver tooth 172 enables the drive pawl distally inclined surface and can cross over the second tooth 220 reaches the proximal end of the track. 当驱动爪160向近侧移动时，在远端的推杆驱动器齿172和止回爪锁键184之间的接触阻止了推杆140在针内腔中向近侧移动并且推杆保持与近侧的T形凸片锚定器80接触，如图29中所示。 When the drive pawl 160 is moved proximally, the contact between the distal end of the push rod driver tooth pawl catch 172 and 184 back stop prevents the push rod 140 in the needle lumen proximally and the pusher maintain close side of the T-shaped projection 80 contacts anchor, shown in Figure 29.
在初始T形凸片展开之后，针52从组织部位上去除并再次插入进第二个靶组织部位。 After the initial T-Tag expand, needle 52 is removed from the tissue site and inserted into a second target tissue site again. 为了将第二T形凸片锚定器在组织中展开，就要向扳机26再次施加手动压力使得扳机在手枪式握把24 的方向上枢转，如图30中所示。 For the second T-Tag anchor in tissue expansion, it is necessary to trigger 26 such that manual pressure applied to the trigger in the direction of pistol grip 24 to pivot, shown in Figure 30 again. 当扳机26枢转时，杠杆178绕销164枢转从而再次向远侧并且沿着推杆驱动器154的边缘推动驱动爪160通过轨道220。 When the trigger 26 to pivot, the lever 178 to pivot about the pin 164 and thereby distally along the edges of the push rod driver 154 drive pawl track 160 by 220 again. 注意驱动爪160 —开始并未与推杆驱动器154的近侧齿接合。 Note that drive pawl 160 - Begin did not engage the proximal push rod driver teeth 154. 当驱动爪160沿着推杆驱动器154前进时，驱动爪接触到近侧的第二推杆驱动器齿。 When the drive pawl 160 advances along the rod driver 154, the drive pawl contacts to a second proximal push rod driver tooth. 当驱动爪接触到第二推杆齿172时，驱动爪向齿施加力，以^使推杆驱动器^^皮推向远侧通过轨道218，该力克服了推杆驱动器弹簧180的反作用力。 When the drive pawl contacts the second push rod tooth 172, the drive pawl applies a force to the teeth, to the push rod drive ^ ^ ^ distally through the skin into the track 218, the reaction force overcomes the push rod driver spring 180. 对于扳机26的第二次挤压过程，驱动爪160推动推杆驱动器154 的距离基本上与T形凸片锚定器的长度相同。 For the second squeeze of the trigger 26 in the process, push drive pawl 160 from drive pusher 154 is substantially T-Tag anchor of the same length. 当推杆驱动器154 前进时，连接的推杆140也会在针52中前进通过T形凸片锚定器 When the push rod driver 154 advance push rod 140 will advance by T-Tag anchor needle 52
24的长度。 Length 24. 在第二扳机冲程的起始位置，推杆140的远端接触到第 In the starting position of the second trigger stroke, the distal end of push rod 140 contacts the first
二T形凸片锚定器80的近端。 Two T-Tag anchor the proximal end 80. 第二T形凸片锚定器的远端悬在针52的开放远端上。 The second T-Tag anchor hanging in the open distal end of the distal end of the needle 52. 当推杆140前进时，推杆向T形凸片锚定器80的近端施加将锚定器弹出针开放远端并进入或通过穿透组织的作用力。 When the rod 140 forward, putting the T-Tag anchor the proximal end 80 of applying a force to penetrate tissue is anchored to eject the needle and into or through the open distal end. 当T形凸片锚定器展开时，连接到T形凸片上的缝线穿过槽88退出针并保持在T形凸片74， 80和钉仓内的缝线腔94之间延伸，如图30中所示。 When the T-Tag anchor is deployed, the suture connected to the T-shaped lug 88 exits the needle through slot and held between the T-shaped tabs 74, 80 and suture cavity 94 extends within the cartridge, such as shown in Figure 30.
在第二T形凸片锚定器已经展开以后，装置20可通过复位将推杆140从钉仓中拉回并进入壳体30。 After the second T-Tag anchor has been launched, the device 20 may be reset and the push rod 140 back into the housing 30 from the staple cartridge. 为了将装置复位，扳机26 克服按钮222的作用力以其最大程度枢转，直到扳机撞到手枪式握把，如图31中所示。 In order to reset the device, trigger 26 to overcome the force of the button 222 is pivoted at its maximum extent, until the pistol grip trigger hit, 31 as shown in FIG. 将初级扳机完全地枢转甚至会将驱动爪160向远侧推动至抵接到止回爪182。 The completely pivoting primary trigger will even push drive pawl 160 distally to abut the backstop claw 182. 当驱动爪160前进时，销166继续跟沿着凸轮表面230的过渡至驱动爪轨道220的上表面行进。 When the drive pawl 160 advances, the pin along the cam surface 166 to continue with the transition to the upper surface 230 of drive pawl track 220 travel. 凸轮表面230在图24中详细地示出。 Cam surface 230 shown in detail in FIG. 24. 当销166到达凸轮表面230时，锁键170绕止回爪锁键184穿过并与止回爪的凸轮表面185接触。 When the pin 166 reaches the cam surface 230, the latch 170 around the backstop claw catch 184 passes through and is in contact with the cam surface of the backstop claw 185. 与凸轮表面230的接触迫使销166及对应的驱动爪160和止回爪182向下。 Contact with the cam surface 230 forces the pin 166 and the corresponding drive pawl 160 and anti-backup pawl 182 downward. 当两个爪都向下移动时，爪/人推杆驱动器154的齿172脱离，如图31中所示。 When the two jaws are moved downwardly, jaw / person push rod driver 154 from the teeth 172, as shown in FIG. 31. 解除了爪的作用力，弹簧加载的推杆驱动器154由推杆驱动器弹簧180的作用力向近侧驱动回到其轨道218末端上的最初的近侧起始点。 He lifted the claw force, push rod driver 154 by the force of the spring-loaded push rod driver spring 180 proximally drive back to the original starting point of the proximal end of the track 218 on its. 当推杆驱动器154 缩回时，驱动器将推杆140从针52上拉出并将推杆复位回至其在壳体30和推杆护套142内的最初位置。 When the push rod driver 154 is retracted, the drive rod 140 and the plunger is pulled out from the pin 52 is reset back to its original position within the housing 30 and the push rod sheath 142. 对推杆140的复位可以在第二T形凸片展开之后的任何时间发生，但是必须在将钉仓32 从壳体30上去除或钉仓不能进行旋转之前实施。 Of the push rod 140 is reset at any time of the second T-Tag, after expansion occurs, but must be removed before the cartridge 32 from the housing 30 or the cartridge can not be rotated implemented. 另外，如果推杆140在展开第二T形凸片锚定器之前进行复位，扳机26的两个致 In addition, if push rod 140 prior to the commencement of the second T-Tag anchor is reset, the two actuation trigger 26
动装置将仍会展开第二组织锚定器。 Actuating means will still start the second tissue anchor.
在第二T形凸片锚定器已经展开并且装置20选择复位以后， 壳体30和钉仓32通过手动按压按钮132和沿着手柄中的轨道134 Has started and the device 20 to select Reset in the second T-Tag anchor later, the housing 30 and the cartridge 32 by manually pressing the button 132 and the track 134 along the handle
25滑动柱杆130^^皮推向远侧，如图32中所示。 25 ^^ slide post 130 to the distal sheath, shown in Figure 32. 向远侧推进4丁仓32 将针52隐藏回针腔144内部，从而针尖就安全地处于钉仓内。 Advanced distally 4 small compartment hidden 144 52 32 needle back inside of needle cavity, which tip it is safely within the cartridge. 当钉仓前进时，开放通道34向远侧在静止的缝线抓紧构件200周围穿过。 When the cartridge forward, open channel 34 in the stationary suture grasping member 200 distally through the surrounding. 当钉仓前进到缝线抓紧构件200的前方时，跨过通道34后面的缝线被抓进钩202的开口中，如所示。 When the cartridge is advanced to the front suture grasping member 200, across the channel 34 back into the suture is caught hook opening 202, as shown. 钩202的开口如图25 所示可以是锥形的，以帮助将缝线引导进钩中。 Hook opening 202 as shown in Figure 25 may be tapered to help guide the suture into the hook. 如果缝线长度93 :帔夹在钩202内时，向近侧的手动4^力^皮施加到旋4丑216上。 If the length of the suture 93: cape clamped in the hook 202, a manual proximal force to 4 ^ 4 ^ 皮施加 to spin 216 ugly. 在旋扭216的作用力通过拉杆212传递到滑梭204上，将滑梭和对应的缝线抓紧构件202向近侧拉进壳体中。 The knob 216 by the force rod 212 is transmitted to the shuttle 204, the shuttle and the corresponding suture grasping member 202 proximally pulled into the housing. 缩回滑梭204的作用力压缩了收紧弹簧210。 Retracting shuttle 204 compresses the tightening force of the spring 210. 当缝线抓紧构件200向近侧移动时，钩202抓取并缩回缝线长度93,通过将缝线从缝线结82拉出以施加使缝线长度84变短的张力，并且钩202将展开的T形凸片锚定器74, 80拉到一起放在周围组织附近。 When the suture grasping member 200 moves proximally, grab hook 202 and retract the suture length 93 by the suture from the suture knot 82 is pulled out to apply the suture tension shorter length 84, and the hook 202 The expansion of T-Tag anchors 74, 80 pulled together in the vicinity of the surrounding tissue. 如上所述，缝线的松弛端86 被锁定在钉仓32内部的终止凹槽102中。 As described above, loose ends of the suture 86 is locked in the cartridge 32 inside the terminal groove 102. 因此，缝线长度93被卡在终止凹槽102中的固定端和连接在T形凸片锚定器20内的第二端之间。 Thus, suture length 93 is caught between the termination of the groove 102 and the fixed end connected within T-Tag anchor 20 of the second end. 因此，当缝线长度93在壳体30中被钩202拉向近侧时，在缝线中会产生将T形凸片锚定器拉到一起的张力，如图33 中所示。 Therefore, when the length of the suture 93 in the housing 30, the hook 202 is pulled proximally, the sutures will produce the T-Tag anchors pulled together in tension, as shown in Fig. 33.
在缝线已经收紧以使T形凸片锚定器74, 80设置成隔开期望的距离之后，缝线抓紧构件200通过释放旋扭216上的向近侧的拉力而复位。 In the suture has been tightened to make T-Tag anchor 74, 80 is set to a desired distance apart after suture grasping member 200 proximally through the release of the tension knob 216 is reset. 当旋扭216和如此在滑梭204上的作用力消失时， 在压缩的收紧弹簧210内的作用力被释放了。 When the knob 216 and so force the shuttle 204 disappeared, the force within the compressed cinching spring 210 is released. 收紧弹簧210张开并向前驱使滑梭204和连接的缝线抓紧构件200到达壳体30的远端，从而复位缝线抓紧构件。 Tightening the spring 210 to open and forward-driven shuttle 204 and the attached suture grasping member 200 reaches the distal end of the housing 30, thereby resetting the suture grasping member. 在缝线收紧之后，在第二T形凸片锚定器和缝线腔94远端之间延伸的缝线被切断，从而将T形凸片锚定器从钉仓上分离。 After tightening the sutures, the suture is cut off in the second T-Tag anchors extending between the cavity 94 and the distal end of the suture, which will T-Tag anchors are separated from the cartridge. 切割构件112可用于通过将缝线缠绕通过V形凹口122切断缝线，如图34中所示。 Cutting member 112 may be used to sever the suture by wrapping the suture through V-shaped notch 122, as shown in FIG. 34. 抓紧器可用于辅助将缝线拉进V形凹口。 Grasper can be used to assist the suture pull into the V-shaped notch. 如果缝线在V形凹口122内部，拉力被施加到手柄22上将缝线张紧于切割构件的刀片120上以便切断缝线。 If the suture inside V-notch 122, tension is applied to the handle 22 will tension the suture cutting blade member 120 in order to sever the suture. 如果分开的抓紧器用具没有用于辅助切割，张力可以通过向旋扭216 施加所需的作用力而被施加到缝线上以辅助切割。 If there is no separate grasper tool used to assist the cutting, tension can be applied to the knob 216 the desired force is applied to the suture to assist with cutting. 作为使用切割构件112的替代方式，从收紧的T形凸片锚定器上延伸的缝线可以通过使已知的外科器械穿过套管针或其他手术端口或开口予以切断，以便抓住和切断缝线。 As an alternative to using a cutting member 112, the suture extending from the tightening of the T-Tag anchors may be cut off by making known surgical instruments through the trocar or other surgical port or opening, in order to seize the and sever the suture.
缝线切断以后，如果装置在收紧T形凸片锚定器之前还未复位，推杆140可以复位进壳体30中。 After cutting the suture, if the tightening means before the T-Tag anchor has not been reset, the push rod 140 can be reset into housing 30. 在装置复位并且切断缝线之后，钉仓可以从装置上去除。 After the device is reset and cut sutures, the cartridge can be removed from the device. 为了去除钉仓32,钉仓以上面介绍过的方式相对于壳体旋转，从而使得钉仓从壳体的远端滑脱。 To remove the cartridge 32, the cartridge in the manner described above with respect to the housing through the rotation, so that the cartridge from sliding off the distal end of the housing. 如上所述，在切断收紧的缝线的过程中，多余的缝线被保留在钉仓缝线腔94内并且通过尺寸增强元件IIO保持连接在钉仓上。 As described above, in the process of cutting the suture tightening, the excess suture is retained within the suture cartridge chamber 94 and the reinforcing elements by size IIO remains attached to the cartridge. 当钉仓从壳体30上去除时，多余的缝线在抓紧构件200周围滑动并滑出壳体，与钉仓保持在一起。 When the cartridge is removed from the housing 30, the excess suture grasping member 200 slip and slide around housing, held together with the cartridge. 因此，多余的缝线在使用后随着钉仓一起抛弃。 Thus, excess suture cartridge after use with abandon together. 在钉仓从壳体上去除后，展开装置20准备好再次连接到另外的钉仓并与另外的钉仓一起使用。 After the cartridge is removed from the housing, deploying device 20 is ready to connect again to another cartridge and used with another cartridge.
图35示出了展开装置的第二种实施方式。 Figure 35 shows a second embodiment of the expansion device. 在该实施方式中， 钉仓32基本上与前面的实施方式中的钉仓相同。 In this embodiment, the cartridge 32 is substantially the previous embodiment the same cartridge. 然而，手柄发生了改变使得装置能够单手操作以展开T形凸片锚定器和收紧及切断缝线。 However, the handle is changed so that the device is capable of single-handed operation to expand the T-Tag anchors and tighten and cut off the sutures. 在该实施方式中，第二只手仅需要操作按钮132以推进和缩回壳体30。 In this embodiment, the second hand 132 only needs to operate the button 30 to advance and retract the housing. 如图36至37中所示，在该第二种实施方式中， 手柄22改变成包括圆柱形推杆护套固定器232。 As shown in FIG. 37 to 36, in the second embodiment, the handle 22 is changed to include a cylindrical push rod sheath holder 232. 推杆护套142的近端被连接到推杆护套固定器232的远端。 The proximal end of push rod sheath 142 is connected to the distal end of push rod sheath holder 232. 推杆护套固定器232 与壳体30共轴并且恰好位于手柄通道126内的壳体近侧。 Push rod sheath holder 232 and 30 of the shaft housing and the housing is located just proximal handle channel 126 inside. 推杆护套固定器232的远端片段直径比壳体30小，使得片段能够在壳体内部滑动。 The distal end of push rod sheath holder 232 fragment smaller than the diameter of the housing 30, so that the fragment is capable of sliding in the interior of the housing. 在推杆护套固定器232远端片段的上表面中形成了轴向延伸的凹槽234,该凹槽具有弯曲的端面。 On the surface of the distal end of push rod sheath holder 232 is formed in the groove segments 234 extending axially, the recess having a curved end faces. 销236连接到壳体30的近端附近以便横跨推杆护套固定器的凹槽234。 Pin 236 near the proximal end connected to the housing 30 so as to cross the push rod sheath holder groove 234. 当壳体30由 When the housing 30 is made
27按钮132缩回或推进时，销236在护套固定器的凹槽234中滑动。 27 button 132 to retract or advance, the pin 236 slides in the sheath holder groove 234. 当销236在固定器的凹槽234中滑动时，推杆护套固定器232随着壳体30滑过固定器推杆护套固定器232而在手柄通道126内保持静止。 When the pin 236 slides in the holder groove 234, push rod sheath holder 232 as housing 30 slides holder and push rod sheath holder 232 remains stationary within handle channel 126. 在穿过固定器的凹槽234的长度之后，销236接触到凹槽的一个弯曲端。 After passing through the length of holder groove 234, the pin 236 contacts a curved end recess. 在移动的销236和固定器的凹槽234弯曲端面之间的接触沿着与壳体30相同的方向驱动推杆护套固定器232。 The contact between the recess 234 and the curved end surface fixator pin 236 moves along the same direction as the housing 30 driving the push rod sheath holder 232. 为了缩回推杆护套142(还有连接的针52),随着柱杆130沿着轨道134从远侧凹部移动到近侧凹部，销236将推杆护套固定器232 向手柄通道126的近端驱动。 To retract the push rod sheath 142 (and attached needle 52), with the post 130 along track 134 to move from the distal to the proximal recess recess, the pin 236 will push rod sheath holder 232 to handle channel 126 The proximal end of the drive. 推杆护套固定器232中的凹槽234 长度与钉仓32缩回的距离相符以便将针52从钉仓远端暴露出来。 232 push rod sheath holder 32 is retracted from the recess 234 matches the length of the cartridge so that the needle 52 is exposed from the distal end of cartridge. 一旦销236接合凹槽234的近侧端面，壳体30和推杆护套固定器232共同行进的距离对应于针向近侧被拉回的距离，以^更^f吏推杆140的远端与针52内的T形凸片锚定器叠层的近端对准。 Once pin 236 engages the proximal end face of groove 234, the housing 30 and push rod sheath holder 232 travel together corresponds to the distance of the needle is retracted proximally a distance, to more ^ f ^ Officials distal push rod 140 T-shaped end of the needle 52 within the anchor tabs aligned with the proximal end of the laminate. 销236 和凹槽234端面之间的接触使得推杆护套固定器232和推杆护套142能够通过按钮132依次与壳体30 —起往复运动。 Contact pins 236 and grooves 234 between the faces so that the push rod sheath holder 232 and the push rod sheath 142 sequentially through button 132 and the housing 30-- from reciprocate.
图38至40示出了当推杆护套固定器232和壳体30缩回时， 针52和推杆140在钉仓32内的相对位置。 Figure 38-40 shows when the push rod sheath holder 232 and the housing 30 is retracted, the pin 52 and the push rod 140 relative position within the cartridge 32. 注意，为了清楚起见， 缝线长度84和93的运动、缝线抓紧构件200和滑梭204从这些图上省略了。 Note that, for clarity, the suture length 84 and 93 of the movement, the suture grasping member 200 and the shuttle 204 are omitted from these figures. 图38示出了完全封闭在钉仓32内的针52，和与推杆护套142的远端相邻的推杆140。 Figure 38 shows a fully enclosed within the cartridge 32, needle 52, and a push rod sheath 142 adjacent the distal end of the pusher 140. 该针和推杆的位置对应于在图36中所示的手柄位置，其中按钮132完全地在轨道134的远侧， 以将钉仓和壳体放置在前方位置。 The needle and push rod position corresponds to the handle position shown in FIG. 36, in which button 132 is fully distal in track 134 to the cartridge housing and placed in the forward position. 当按钮132向近侧滑动时，销236移动通过推杆固定器的凹槽234，使得壳体30能够相对于静止的推杆护套固定器232滑动。 When the button 132 is slid proximally, pin 236 moves through push rod holder groove 234, such that the housing 30 relative to the stationary push rod sheath holder 232 to slide. 当壳体移动时，钉仓32也向近侧移动。 When the housing movement, cartridge 32 also moves proximally. 针52经由推杆护套142连接到护套固定器232上。 Pin 52 is connected to the sheath holder 232 via the push rod sheath 142. 因此， 由于护套固定器是静止的，针也是静止的，使得钉仓32远离针缩回从而暴露出针的远端，如图39中所示。 Accordingly, since the sheath holder is stationary, the needle is also stationary, so that cartridge 32 is retracted away from the needle so that the distal end of the needle is exposed, as shown in FIG. 39. 当销236接触到固定器凹槽234的近侧端面时，销在手柄通道126内向近侧推动推杆护套固定器232。 When the pin 236 contacts the holder recess 234 when the proximal end face of the pin push rod sheath holder 126 proximally within handle channel 232. 当推杆护套固定器232移动时，固定器将针52向近侧拉，这是由于推杆护套142和针之间的连接机构。 When the push rod sheath holder 232 moves the needle holder 52 proximally, push rod which is due to the connection mechanism between the sheath 142 and the needle. 当针52向近侧移动时，T形凸片锚定器叠层的近端被拉向推杆140的远端。 When the needle 52 moves proximally, T-Tag anchor stack is pulled toward the proximal end of the distal end of the pusher 140. 当推杆护套固定器232降到手柄通道126近端的最低点时，T形凸片锚定器叠层接触到推杆140 (如图40中所示）。 When the push rod sheath holder 232 to a minimum proximal handle channel 126, T-Tag anchor stack contacts to push rod 140 (as shown in FIG. 40). 在这点上， 柱杆130在按钮弹簧136的作用下跳起沿着轨道134进入到近端凹槽以将针锁定到位。 At this point, post 130 jumps under the action of the button spring 136 along the track 134 into the proximal end of the needle groove to lock into place. 伴着推杆140接触T形凸片锚定器叠层， 扳机26现在准备好被挤压以便展开初始的T形凸片锚定器。 Accompanied push rod 140 contacts T-Tag anchor stack, trigger 26 is now ready to be squeezed in order to expand the initial T-Tag anchor.
在该实施方式中，紧固件以与前面介绍过的实施方式基本相同的方式展开。 In this embodiment, the fastener with the embodiment described earlier in substantially the same fashion. 具体地，如图27到31所示，在展开T形凸片锚定器之前，驱动爪160与推杆驱动器154上的远侧齿接触。 Specifically, as shown in Figure 27 to 31, prior to deployment T-Tag anchors drive pawl 160 in contact with the distal tooth on push rod driver 154. 当扳机26被挤压时，驱动爪推动推杆驱动器154，其又将推杆140推到T形凸片锚定器叠层上以展开第一T形凸片锚定器。 When the trigger 26 is squeezed, drive pawl push rod driver 154, which in turn push rod 140 is pushed to the T-Tag anchor stack to deploy the first T-Tag anchor. 当扳机26 被挤压时，指示T形凸片已经展开的触觉反馈被提供给外科医生。 When the trigger 26 is squeezed, indicating T-Tag has been deployed tactile feedback is provided to the surgeon. 在第二种实施方式中，该触觉反馈是由在扳机26和手枪式握把24的基部上的闭锁机构280提供的，如图36中所示。 In a second embodiment, the haptic feedback is on the trigger 26 and pistol grip 24 of the base portion 280 to provide a latching mechanism, as shown in FIG. 36. 在第一T 形凸片锚定器展开之后，闭锁机构280脱离并且释放扳机26,使得驱动爪160能够弹回到其初始位置。 In the first T-Tag anchor is deployed later, the latching mechanism 280 and releases the trigger from 26, so that the drive pawl 160 can spring back to its original position. 当驱动爪160弹回时，推杆驱动器154保持静止，这是由于近端的第一推杆驱动器齿和止回爪182之间的接触，如图29中所示。 When the drive pawl 160 springs back, push rod driver 154 remains stationary, which is due to the proximal end of the first push rod driver tooth and anti-backup pawl 182 between contacts, shown in Figure 29. 当驱动爪160弹回时，驱动爪锁键啮合更近侧的第二推杆驱动器齿。 When the drive pawl 160 springs back, the drive pawl catch engages the second more proximal push rod driver tooth. 这将驱动爪160放置到位以使推杆驱动器154再次与下一次扳机挤压过程一起前进， 以将推杆140进一步向远侧驱动从而弹开第二T形凸片锚定器。 This will drive pawl 160 is in place to make the push rod driver 154 again with the next trigger squeeze together the process proceeds to the push rod 140 further distally driven to bounce a second T-Tag anchor. 有了这个机构，扳机26的每次挤压过程都会将推杆向远侧推动大约一个T形凸片锚定器的长度。 With this mechanism, each squeeze of the trigger 26 are distally pushing the plunger about a T-Tag anchor length. 该方法有效，因为T形凸片叠层最初是与推杆直接接触的，这明显不同于第一实施方式中。 This approach works because the T-Tag stack is initially in direct contact with the putter, which is significantly different from the first embodiment.
在第一T形图片锚定器的展开和第二T形凸片锚定器的展开之间，按钮132可被向远侧拉出轨道134的全长从而将钉仓32向远侧拉过针52的尖。 Between the first T-shaped image anchor deployment and the second T-Tag anchor deployment, button 132 may be pulled out of a total length of track 134 distally thereby pull cartridge 32 distally over needle tip 52. 如果盖住了针尖92,展开装置20可用于探 If you cover the needle 92, deploying device 20 may be used to explore
查腔壁并确定第二耙组织区。 Charles cavity wall and determine the second rake tissue area. 在确定了期望的组织部位之后，按 After determining the desired tissue site after the press
钮132被再次按下使得柱杆130向近侧滑动过轨道134的全长进而暴露出针52并将针52拉回。 Button 132 is pressed again so that the post 130 to slide proximally over the full length of track 134 to expose needle 52 and thus needle 52 back. 当针被拉向近侧时，推杆140接触到第二T形凸片锚定器的近端。 When the needle is pulled proximally, push rod 140 contacts the second T-Tag anchor the proximal end. 装置20因而准备好了击发紧固件的第二T形凸片锚定器。 20 thus ready fastener firing a second T-Tag anchor.
在第二T形凸片锚定器展开后，装置可通过复位来将推杆140 放回壳体30内部。 In the second T-Tag anchor is deployed, the device can be reset to the push rod 140 back into the interior of the housing 30. 在本文描述的第二种实施方式中，致动器进一步包括次级扳机240。 In a second embodiment described herein, the actuator further includes a secondary trigger 240. 次级扳机240位于手柄22远侧边上，在初级扳机26和壳体30之间，并且在容易被握住初级扳机的同一只手够到的范围内。 Secondary trigger 240 is located in the distal side of handle 22, between the primary trigger 26 and housing 30, and is easily within the grasp of the same hand the primary trigger reach range. 次级扳机240的一个功能是控制装置复位。 Secondary trigger 240 is a function of the control device is reset. 如图41至43中所示，次级扳机240包括在扳机固定端的凸轮表面274。 As shown in Figure 41-43, secondary trigger 240 includes a cam surface 274 of the fixed end of the trigger. 凸轮表面274停在释放柱杆276的一端上，其包含在初级扳机26之内。 Cam stop surface 274 on one end of release post 276, which is contained within the primary trigger 26. 伴着扳机26被闭锁机构280保持就位，释放柱杆276 的相对端接触到驱动爪160的近端。 Accompanied trigger 26 held in place by latching mechanism 280, releasing the opposite end of the pole 276 contacts the proximal end 160 of the drive pawl. 伴着初级扭j几26通过闭锁机构280保持就位，展开装置通过挤压次级扳机240从而使次级扳机朝向初级4反机旋转的方式被复位。 Accompanied by a few primary twist j 26 280 held in place by a latching mechanism, expand the device by squeezing the secondary trigger 240 so that the secondary trigger towards the primary 4 anti-rotating manner is reset. 当次级扭^几旋转时，释放柱杆276被迫跟随以倾斜角度铺展的凸轮表面274的路径。 When the secondary twisting ^ several rotates, release post 276 forced to follow in order to spread the inclination angle of the cam surface 274 of the path. 当释放柱杆276随着倾斜的凸轮表面274行进时，释放柱杆被向上驱动到驱动爪的近端，如图43中所示。 When the release post 276 with inclined cam surface 274 when traveling, release post is driven up to the proximal end of the drive pawl, as shown in FIG. 43. 这个在驱动爪160上的向上作用力使驱动爪绕着销168枢转，导致驱动爪锁键170向后移动。 This upward force on drive pawl 160 of the drive pawl pivot about the pin 168, causing the drive pawl catch 170 to move backward. 当驱动爪160上的锁键向下枢转时，位于驱动爪的边之间的销166 接合到止回爪锁键184的前端，迫使止回爪锁键也以向下的方向绕着销186枢转。 When the lock button on the drive pawl 160 to pivot downward, the pin 166 between the edge of the driver to stop engaging claw back the front end 184 of the latch jaw, forcing backstop claw lock keys are also in a downward direction about the pin 186 pivot. 当驱动爪160和止回爪182在释放柱杆276的作用下向下旋转时，推杆驱动器154上的次级齿从爪上解放，使得弹簧加载的推杆驱动器能够缩回到其最初的近侧位置。 When the drive pawl 160 and anti-backup pawl 182 is rotated downward under the action of release post 276, putting the secondary drive teeth liberation from the claws 154, so that the spring-loaded push rod driver can be retracted to its original proximal position.
复位展开装置的这个方法可联合收紧缝线的动作，从而使T 形凸片锚定器在一起。 This method of resetting the deploying device can be combined suture tightening operation, so that the T-Tag anchors together. 图37、 41和42示出了收紧缝线的替代实施方式，其中用到了次级扳机240在松弛的缝线长度上拉动。 37, 41 and 42 show an alternative embodiment of the suture tightening, which uses a secondary trigger 240 pulled on the loose suture length. 在 In
该实施方式中，正如在前面的实施方式中，缝线抓紧构件200位于壳体30内用来抓取到跨过钉仓近端的一段缝线上。 In this embodiment, as in the previous embodiment, a suture grasping member 200 is located within the housing 30 is used to fetch the cross section of the proximal end of the suture cartridge. 缝线抓紧构件200被再次连接到滑梭204上。 Suture grasping member 200 is attached to the shuttle 204 again. 同样地，收紧弹簧210 (具有多个弹簧和连接片208 )再次从滑梭204基本通过壳体30的长度向近侧延伸，用来在收紧之后对缝线抓紧构件200进行复位。 Similarly, tightening the spring 210 (having a plurality of springs and connecting pieces 208) again from shuttle 204 substantially the length of the housing 30 extends proximally, for tightening after reset suture grasping member 200 through. 然而，在该实施方式中，柔性的拉动构件242被连接到滑梭204的近端从而在壳体内将滑梭向近侧拉动。 However, in this embodiment, the flexible pulling member 242 is connected to the proximal end of shuttle 204 within the housing so that the shuttle pulled proximally. 如图37中所示，柔性的拉动构件242延伸滑梭204的近端通过收紧弹簧210和连接片208。 As shown in Figure 37, the flexible pulling member 242 extends proximal of shuttle 204 through cinching spring 210 and connecting plate 208. 柔性的拉动构件242的近端连接到手柄通道126端部的线轴244 上。 The proximal end of flexible pulling member 242 is connected to the spool 244 of handle channel 126 ends. 如图41中所示，皱褶或结241形成在拉动构件242的近端中用来在线轴244中的槽内保持拉动构件。 41 is formed as shown in FIG, wrinkles or knot 241 in the proximal end of the pulling member 242 to the spool 244 in the pull holding tank member. 柔性的拉动构件242被 Flexible pulling member 242
在手柄22内旋转，将柔性的拉动构件242缠绕到线轴上。 Within the handle 22 is rotated, the flexible pulling member 242 is wound onto spools. 当拉动构件242缠绕到线轴244上时，拉动构件经由滑梭204向缝线抓紧构件200施加指向近侧的作用力，将缝线向近侧拉进壳体30中。 When pulling member 242 is wound onto the spool 244, the pulling member via shuttle 204 to suture grasping member 200 proximally directed force is applied, the suture proximally into housing 30. 在该实施方式中，线轴244通过向次级扳机240施加挤压运动来旋转。 In this embodiment, the spool 244 by applying a squeezing motion to secondary trigger 240 to rotate. 如图41、 42和45中所示，杠杆246 ^皮连接到次级4反机240上并且响应4反机的运动而枢转。 41, 42, and as shown in Figure 45, the lever 246 is connected to the secondary skin ^ 4 240 anti-aircraft and anti-aircraft 4 in response to movement of the pivot. 杠杆246又连接到以一定角度朝向手柄近端倾斜的架250上。 Lever 246 is in turn connected to the handle at an angle towards the proximal end of the inclined frame 250. 杠杆引导件248延伸越过杠杆246并且部分地沿着架250延伸以将杠杆约束在架上。 248 lever guide extends beyond the lever 246 and 250 extend partially along rack to leverage constraint on the shelf. 杠杆引导件248由壳体内的特征部保持就位并且具有用于驱动爪弹簧174的路径。 Characterized by the lever guide member 248 is held in place within the housing and having a path for the drive pawl spring 174. 架250包括多个齿，其接合复合齿轮252。 Frame 250 includes a plurality of teeth, which engages gear 252 compound. 复合齿轮252又与线轴齿轮254匹配，其就附于线轴244上。 Compound gear 252 and the spool gear 254 matches, which will be attached to the spool 244. 弹簧256被连接到架250上以驱动架250、杠杆246和次级扳机240返回起始位置。 Spring 256 is attached to the frame 250 to drive the rack 250, 246 and secondary trigger lever 240 return to the starting position. 线轴驱动器260附于线轴齿轮254,以便通过齿轮进行旋转。 Spool drive gear 260 is attached to the spool 254 to rotate through the gears. 线轴驱动器260包括多个驱动销262,其使得线轴第一边上的开口环或齿环264;J走转。 Spool drive 260 includes a plurality of drive pins 262, which causes the spool of the first side of the split ring or ring gear 264; J go turn. 线轴止回爪266位于线轴244的相 Spool anti-backup pawl 266 is located relative to the spool 244
31对边，以便啮合在线轴的相对边上的第二开口环或齿环270。 31 pairs of sides to engage opposite sides of the spool of the second split ring or ring gear 270. 如 As
图36和41中最佳所示，在第二环270上的线轴开口是由顺时针方向的斜面和逆时针方向的截止面形成。 As best shown in Figures 36 and 41, on the second ring of the spool 270 is off the opening face of the clockwise and counterclockwise directions inclined surface is formed. 释放按钮272往复地连接到线轴齿轮254的轴上，与线轴止回爪266是偏置的关系。 Release button 272 is reciprocally connected to the shaft of spool gear 254, and the spool anti-backup pawl 266 is biased relationship. 当按钮向着线轴齿轮254按下时，线轴止回爪266的部分267在释放按钮272的方向上向外突出来实现与按钮的接触。 When the button is pressed toward the spool gear 254, the spool 266 of the anti-backup pawl portion 267 projecting outwardly in the direction of the release button 272 to achieve contact with the button.
在第二T形凸片锚定器80展开和装置复位之后，次级扳机240被挤压从而收紧在T形凸片锚定器之间的缝线（将推杆复位到其起始位置）。 After the second T-Tag anchor 80 to expand and reset means, secondary trigger 240 is squeezed thereby tightening the T-Tag suture between anchors (resetting the push rod to its starting position ). 挤压次级扳机240驱动杠杆246进入架250,其又向近侧移动，带动复合齿轮252旋转。 240 secondary trigger squeeze the drive lever 246 into the frame 250, the ED proximal movement, driven composite gear 252 is rotated. 复合齿轮252的旋转又带动线轴齿轮254旋转。 Rotational gear 252 and drive gear 254 spinning reel. 附装于线轴齿轮254的驱动销262啮合线轴齿264，从而带动线轴244响应线轴齿4仑的旋转运动而旋转。 Attached to the spool gear 262 of the driving pin 254 engages spool teeth 264, so as to drive the spool 244 in response to rotational movement of the spool 4 gallons tooth rotates. 当线轴244旋转时，柔性的拉动构件242被拉向近侧通过手柄22并缠绕到线轴上。 When the spool 244 rotates, flexible pulling member 242 is pulled proximally through handle 22 and wound onto spools. 在图中所示的实施方式中，架和齿轮被设计成带动线轴244以顺时针方向旋转从而缠绕拉动构件242。 In the embodiment shown in the figures, the rack and gears are designed to drive the spool 244 in a clockwise direction thereby pulling member 242 is wound. 正如所示，线轴齿轮254和复合齿轮252被选取成能让T形凸片锚定器通过次级:板机240的两次挤压过程而被完全地收紧到一起。 As shown, spool gear 254 and compound gear 252 are selected to make the T-Tag anchor through the secondary: is fully tightened to the plate 240 twice during extrusion machine together. 在负载、传动比和用户需要之间的平衡允许对收紧率进行所期望的细细（若干次挤压过程）或粗糙（少至一次挤压过程）的控制。 Balance between load, gear ratio and allows users need to tighten rates desired thin (several extrusion process) or coarse (as little as one extrusion process) of control. 线轴止回爪266允i午线轴244纟皮驱动销带动^走转。 Spool anti-backup pawl 266 allows spool 244 i afternoon drive pin drive ^ Si skin turn away. 线轴止回爪266通过骑坐在开口的斜面上而在第二环270中的齿之间移动。 Spool anti-backup pawl 266 and the second ring 270 between the teeth to ride sitting on the ramp moves through the opening. 线轴止回爪齿270内的不同表面允许线轴244在拉紧柔性拉动构件242的方向上旋转，但在次级扳机被释放时会阻止线轴在释放拉动构件的逆时针方向上旋转，比如在挤压过程之间。 Spool back into the prong 270 different surface tension only allows the spool 244 in the direction of the flexible pulling member 242 is rotated, but the secondary trigger is released prevents the spool is rotated in the counterclockwise direction to release the pulling member, such as in crowded Pressure between processes. 当次级4反机240被释放时，线轴齿270的截止面和止回爪266的末端之间的接触阻止了线轴在解开拉动构件的方向上旋转。 When the secondary 4 anti-aircraft 240 is released, the spool teeth 270 cut-off surface and anti-backup pawl 266 between the contact tip prevents the spool rotates in the direction of unlock pulling member. 一旦次级扭^/L被释放，驱动销就被允许沿着线轴齿264旋转。 Once the secondary twisting ^ / L is released, the drive pin was allowed to rotate along spool teeth 264. 因此，多次挤压过程可被施加到次级扳机240上而不会使拉动构件242被意外地从线轴上释放开。 Thus, the extrusion process may be repeatedly applied to secondary trigger 240 without pulling member 242 will be opened accidentally released from the spool. 这时，缝线可用上面介绍过的钉仓切割构件112切断。 At this time, the suture may be introduced above the cartridge cutting member 112. 替代地，缝线可用传统的外科切割器械切断，该器械穿过一个或多个端口到达收紧的T形凸片锚定器。 Alternatively, the suture may be cut off traditional surgical cutting instrument, the instrument through one or more ports to reach the tightening of T-Tag anchor.
在拉动构件242已经充分地缠绕到线轴244上来将缝线张紧并且将T形凸片锚定器收紧在一起之后，缝线抓紧构件200被复位到其在壳体远端的初始位置。 Pulling member 242 has been sufficiently wound onto spool 244 to tension the suture and the T-Tag anchors together after tightening, suture grasping member 200 is reset to its initial position at the distal end of the housing. 为了复位缝线抓紧构件200,释放按钮272向着线轴齿轮254按下。 To reset suture grasping member 200, release button 272 is pressed toward the spool gear 254. 当释放按钮272被按下时，按钮接触到线轴止回爪266突出的部分267，在止回爪中产生了驱动止回爪末端脱离线轴齿270的杠杆。 When the release button 272 is pressed, the button access to spool anti-backup pawl 266 prominent part 267, resulting in a drive backstop claw tip from spool teeth 270 lever backstop claws. 当线轴止回爪266脱离了线轴齿270时，线轴244不再能阻止线轴的松开。 When the spool anti-backup pawl 266 from the spool teeth 270, the spool 244 is no longer able to prevent the spool release. 如果线轴能自由松开的话，收紧的弹簧210扩张，将驱动滑梭204和连接的缝线抓紧构件200在壳体内向近侧回到它们的初始位置，这导致了拉动构件完全从线轴上松开。 If the spool free to loosen, then tighten the spring 210 to expand, driving shuttle 204 and the attached suture grasping member 200 proximally within housing back to their original position, which results in a completely pulled from the spool member release. 当缝线抓紧构件200已经返回到其初始位置从而释放了缝线上的张力时，缝线被切断从而将T形凸片锚定器从钉仓上分离。 When the suture grasping member 200 has returned to its original position to release the tension on the suture, the suture is cut off so that the T-Tag anchors are separated from the cartridge. 如果在之前没有实施过，这时缝线可用上面介绍过的钉仓切割构件112切断。 If you had never been in before, then the suture may be introduced above the cartridge cutting member 112. 替代地，缝线可用传统的外科切割器械切断，该器械穿过一个或多个端口到达收紧的T形凸片锚定器。 Alternatively, the suture may be cut off traditional surgical cutting instrument, the instrument through one or more ports to reach the tightening of T-Tag anchor.
如上所述，初级扳机26的下边缘和手枪式握4巴24包括闭锁机构280，其在初级扳机的每次挤压过程之后接合。 As described above, the lower edges of primary trigger 26 and pistol grip 24 include a latching mechanism 4 bar 280 which engages after each squeeze of primary trigger process. 闭锁机构280有助于次级扳机240在缝线收紧和装置复位的过程中发生挤压，这是通过将初级扳机保持在手枪式握把24上并且不妨碍枢转次级扳机。 Locking mechanism 280 helps squeeze occurs secondary trigger 240 and the suture tightening device reset process, which is maintained by the primary trigger on the pistol grip 24 and without prejudice to the pivoting secondary trigger. 闭锁机构280在初级扳机26的每次挤压之后（也就是说，在每个T形凸片锚定器被展开之后）被释放以便从装置中发射额外的T形凸片锚定器。 Locking mechanism 280 after each squeeze of primary trigger 26 (that is, after each T-Tag anchor is deployed) it is released to emit additional T-Tag anchor from the device. 闭锁机构280可通过向4反机26施加在远离展开装置平面的方向上的压力来释放。 Locking mechanism 280 by applying pressure in a direction away from the plane of the deploying device 4 to release the anti-aircraft 26. 这产生了在扳机26上的闭锁机构和手枪式握把24上的闭锁机构之间的缝隙。 This creates a gap between the locking mechanism on the trigger 26 and pistol grip 24 of the locking mechanism. 锁键之间的缝隙使得锁键分离，并且允许初级扳机26远离手枪式握把24弹回 Such that the gap between the lock key lock key separation, and allows primary trigger 26 away from the pistol grip 24 spring back
33到其初始位置。 33 to its initial position.
图46示出了本发明的另一种实施方式，其中钉仓发生了改变而在钉仓一侧提供了缝线开口。 Figure 46 shows another embodiment of the present invention, in which the magazine has changed in the side of the cartridge provides a suture opening. 在该实施方式中，钉仓32通过上面介绍过的任何一种钉仓连接方法再次可移动地连接到展开装置20的远端。 In this embodiment, the cartridge 32 is introduced by any of the above cartridge connection method can be reconnected to the deployment of mobile remote unit 20. 钉仓32包括可缩回的针，该针带有包含了一对至少部分封闭在针内的T形凸片锚定器的紧固件。 Cartridge 32 includes a retractable needle that has included a pair of at least partially enclosed within the needle of T-Tag anchor fasteners. T形凸片锚定器可在插入针52之前用类似于上面介绍过的方式预先用缝线打结在一起。 Way T-Tag anchors available similar prior to insertion needle 52 introduced above pre-tied together with sutures. 在展开前，来自T形凸片锚定器的缝线包含在钉仓中的缝线腔内。 Before the commencement of the suture from the T-Tag anchors is contained in the cartridge of the suture cavity. 缝线的松弛端86从缝线腔通过侧开口282穿到钉仓外，如图47和48所示。 Loose ends of the suture 86 through the side opening 282 from the suture cartridge chamber through the outside, as shown in Fig. 47 and 48. 侧开口282形成为展开装置壳体30远端中的一切口。 Side opening 282 is formed to expand the distal end of the device housing cutout 30. 当钉仓32连接到壳体30上时，切口与靠近缝线腔94近端的钉仓相匹配。 When the cartridge 32 is attached to the housing 30, and close the incision with sutures proximal end of the cartridge chamber 94 matches. 如图49中所示，4丁仓32的近端在缝线腔94近侧开口处向内凹陷形成缝线退出钉仓的通路284。 As shown in Figure 49, the proximal end 32 of cartridge 4 D in the proximal suture cavity opening 94 is formed inwardly recessed suture to exit the cartridge passage 284.
在第三种实施方式中，推杆再次被提供在展开装置内部，用来从钉仓上展开T形凸片锚定器。 In a third embodiment, the push rod is again provided in the expanded internal means for expansion T-Tag anchors from the cartridge. 推杆在T形凸片展开之前是静止在推杆护套内的。 Putt before T-Tag is still in expansion push rod sheath. 当钉仓32连接到装置壳体30上时，推杆护套再次与针的近端相匹配从而将护套连接到针上，并且使推杆与针内腔在轴向上对准。 When the cartridge 32 is attached to the unit housing 30, the push rod sheath again to match the proximal end of the needle so that the sheath is connected to the pin, and the push rod and the needle lumen axially aligned. 如图50中所示，在该实施方式中，手柄22再次包括推杆致动机构，其用来在4反机26 #1挤压时向远侧驱动推杆140通过针。 As shown in Figure 50, in this embodiment, the handle 22 again includes a push rod actuation mechanism, which is used when the machine 4 26 # 1 anti-extrusion ram driver 140 distally through the needle. 在该实施方式中，与第二种实施方式中介绍的连杆相似，该连杆被包含在手柄22中。 In this embodiment, the link with the second embodiment is similar to the way described, the link is contained in the handle 22. 连杆响应扳机26的枢转运动来推动驱动爪160。 Link 26 in response to pivotal movement of the trigger to push drive pawl 160. 驱动爪160最初接合推杆驱动器154的近侧的第一齿。 A first drive pawl 160 initially engages a proximal push rod driver tooth 154. 推杆140以与上面介绍过的相同方式被连接在推杆驱动器154内。 Push rod 140 in the same manner described above had to be connected within push rod driver 154. 当驱动爪160向远侧行进时，推杆驱动器154也向远侧行进，使推杆140在针中的T形凸片锚定器叠层的方向上移动。 When the driving pawl 160 is advanced distally, push rod driver 154 also advanced distally, push rod 140 T-Tag anchor stack in the needle in the direction of movement. 在该实施方式中，连杆在扳机26的每次挤压过程中仅将驱动爪160推动单个T形凸片锚定器的长度。 In this embodiment, only the rod 160 push drive pawl single T-Tag anchor during each squeeze of the length of the trigger 26 in the process. 驱动爪160在每次扳机26的挤压过程中又将推杆140推动一个T形凸片锚定器的长 Drive pawl 160 in the extrusion process 26 of each trigger push rod 140 in turn a T-Tag anchor length
34度。 34 degrees.
为了释放T形凸片锚定器，按钮132向近侧滑动以缩回壳体30和连接的钉仓32，从而将针52从钉仓的远端暴露出来，如图51中所示。 To release the T-Tag anchor, button 132 is slid proximally to retract housing 30 and attached cartridge 32, which will expose the needle 52 from the distal end of the staple cartridge out, as shown in FIG. 51. 一旦针52完全暴露出来了，按钮132就进一步向近侧滑动以在近侧方向上拉动壳体30、钉仓32、推杆护套（连接到壳体内的推杆护套固定器232 )以及针52。 Once the needle 52 is fully exposed, the button 132 to slide further proximally to pull the housing 30 in a proximal direction, the cartridge 32, push rod sheath (connected to the push rod sheath holder within the housing 232) and needle 52. 针52与钉仓32—起被拉向近侧以便将T形凸片锚定器叠层（在针内）的近端拉进接触于静止的推杆140的远端并且将第一T形凸片锚定器推动到针的远端。 32- and 52-pin cartridge from being pulled proximally to the T-Tag anchor stack (in a needle inside) pulled into contact with the proximal end of the distal end of the pusher 140 stationary and the first T-shaped Tag anchor pushes into the distal end of the needle. 与第二种实施方式类似，在该实施方式中，扭j几26保持了用于展开两个T形凸片锚定器的相同冲程。 Similarly with the second embodiment, in this embodiment, a few twisted j 26 maintains the same stroke for deployment of both T-Tag anchors. 在针52从钉仓32暴露出来且推杆140接触到了T形凸片锚定器叠层的近端时，扳机26被挤压来展开第一T形凸片锚定器。 Needle 52 is exposed from the cartridge 32 out of the push rod 140 and when exposed to the T-Tag anchor stack proximal end of the trigger 26 is squeezed to deploy the first T-Tag anchor. 当扳机26被挤压时，驱动爪160向远侧推动推杆驱动器154,引起了推杆140从针中弹出第一T形凸片锚定器。 When the trigger 26 is squeezed, drive pawl 160 advances push rod driver 154 distally, causing push rod 140 first T-Tag from the pop-needle anchor. 在T形凸片锚定器被释放之后，为外科医生提供触觉反馈。 After the T-Tag anchor is released, providing tactile feedback to the surgeon. 图50和51显示了替代的利用了抵抗弹簧296的触觉反馈实施方式。 50 and 51 show an alternative use of the resistance of the spring 296 tactile feedback embodiments. 抵抗弹簧296被连接到扳机26上进而面对手枪式握把24。 Against the spring 296 is connected to the trigger 26 and then face the pistol grip 24. 当扳机26朝向手枪式握把24枢转时，弹簧296的向外弯曲的自由端接触到手枪式握把。 When the trigger 26 toward the pistol grip 24 to pivot outwardly bent free end of the spring 296 comes into contact with pistol grip. 抵抗弹簧296具有高刚度，使得要继续枢转扳机就需要额外的手动挤压压力。 Resistance spring 296 has a high rigidity, so you want to continue to pivot trigger requires additional manual squeezing pressure. 在收到触觉反馈时，或相反在完成4反机沖程时，4反机26就;陂释放了。 Upon receipt of tactile feedback, or otherwise upon completion of 4-stroke anti-aircraft, anti-aircraft 26 to 4; Pei released. 当扳机26就被释放时，驱动爪160向近侧运动回到其初始位置，以前面的实施方式中所介绍过的方式。 When the trigger 26 is released, the drive pawl 160 to move proximally back to its initial position, the way to the front of the embodiments described before. 当驱动爪160向近侧移动时，推杆驱动器154由于与止回爪182的接触而保持前进。 When the drive pawl 160 is moved proximally, push rod driver 154 due to anti-backup pawl 182 contacts and keep moving forward. 然后扳机26第二次被挤压以从针52中展开第二T形凸片锚定器。 Then a second trigger 26 is squeezed to start the second T-shaped pin 52 protruding from the anchor.
在第二T形凸片锚定器展开之后，装置以与前述第一种实施方式相似的方式复位。 In the second T-Tag anchor is deployed later, means the aforementioned first embodiment in a manner similar reset. 也就是说，扳机26被完全地枢转直到撞到手枪式握把24。 In other words, the trigger 26 is fully pivoted until the pistol grip 24 hits. 完全枢转的扳机26进一步将驱动爪160向远侧驱动到止回爪182上，引起了销166向下枢转止回爪锁4建184。 Fully pivoting trigger 26 drives drive pawl 160 further distally to backstop claw 182, causing the pin 166 to pivot downward backstop claw lock 4 build 184. 当销166前进到止回爪锁键184时，销还接触到了手柄中的凸轮表面230,其向下驱动销和对应的爪160, 182。 When the pin 166 advances to backstop pawl catch 184, the pin has come into contact with the handle of the cam surface 230, the drive pin and the corresponding downward claws 160, 182. 当爪向下移动时， 两爪都从推杆驱动器齿172上脱离，使得推杆驱动器154能够弹回其初始的近端位置。 When the moving jaw down, paws are from the push rod driver teeth 172 disengage so that the push rod driver 154 can spring back to its initial proximal position. 当推杆驱动器154缩回时，驱动器将推杆从针52中拉出并将推杆复位回与壳体30 —起。 When the push rod driver 154 is retracted, the drive will pull out and putt putt reset pin 52 from the back of the housing 30-- play.
在展开装置复位之后，松弛的缝线末端86被收紧以将T形凸片锚定器拉在一起。 After deploying device is reset, the loose suture end 86 is tightened to the T-Tag anchors to pull together. 优选地，缝线末端86在此实施方式中是通过用手抓住缝线而张紧的，并且沿着壳体30的轴线给缝线施加作用力。 Preferably, the suture end 86 in this embodiment, the suture is tensioned by manual grasping and applying a force to the suture along the axis of the housing (30). 在这种情况下，缝线优选足够长，从而它能够穿过套管针并且缝线末端86是位于或靠近手柄22。 In this case, the suture is preferably long enough so that it can pass through a trocar and the suture end 86 is located at or near the handle 22. 在T形凸片已经收紧到期望的位置时，松弛的缝线被切断。 When T-Tag has been tightened to the desired position, the loose suture is cut off. 缝线可以用钉仓切割构件切断， 比如上述的，或者用其它已知类型的外科切割器械。 Suture cartridge cutting member can be cut, such as described above, or a cutting instrument with other known types of surgery.
图52示出了本发明的第四种实施方式，其中展开装置发生了改变以包括保护性外护套290,其向远侧延伸超过钉仓的长度。 Figure 52 shows a fourth embodiment of the present invention, wherein the expansion means is changed to include a protective outer sheath 290, which extends beyond the length of the cartridge distally. 外护套290向近侧延伸超过壳体30并且连接在按钮132的近端上。 Outer sheath 290 extends proximally over housing 30 and is connected to the proximal end 132 on the button. 在该实施方式中，按钮132被连接在外护套290上而不是壳体30上，以便相对于钉仓缩回和推进外护套。 In this embodiment, the button 132 is connected to the outer sheath 290 rather than on the housing 30, so that the cartridge is retracted relative to the outer sheath and advance. 壳体30通过位于靠近壳体近端的销300被固定在手柄22内，如图53所示。 Housing 30 is fixed by means of pins located close to the proximal end of the housing 300 in the handle 22, shown in Figure 53. 切割装置比如V凹口294可配在外护套290的远端中，用来在收紧后切断缝线。 Cutting means such as V notch 294 can be equipped with the distal end of the outer sheath 290, and used to cut sutures after tightening. 当按钮132处于远侧位置时，比如在图53中所示，针52隐藏在外护套290内。 When the button 132 is in a distal position, such as shown in Figure 53, the needle 52 within the outer sheath 290 hidden. 当按钮132按下使柱杆130沿着轨道134 滑动，外护套290被沿着钉仓缩回以将针52从钉仓32的远端暴露出来，如图54中所示。 When the button 132 is pressed so that the mast 130 to slide along the track 134, the outer sheath 290 is retracted to expose needle 52 from the distal end 32 of the cartridge, as shown in FIG. 54 along the staple cartridge. 当按钮132和连接的柱杆130位于轨道134的近端时，如图55中所示，外护套290是处于完全缩回位置并且如上述的钉仓联接构件被暴露出来从而允许对钉仓的去除和替换。 When the button 132 and the mast 130 is connected at the proximal end of the track 134, as shown in Fig. 55, outer sheath 290 is in the fully retracted position as described above and the coupling member cartridge is exposed so as to allow for the cartridge removal and replacement. 在该实施方式中，钉仓32发生了改变因而针52保持在钉仓远端上的固定的、暴露的位置。 In this embodiment, the cartridge 32 is changed so that the needle 52 is maintained at the distal end of the cartridge fixed, exposed position. 针和在前面的实施方式中一样不会通过针通道推进和缩回。 Needle and as in the previous embodiment will not advance and retract through a needle channel. 锚定器74, 80被预加载在针52中以便用装置展开。 Anchor 74, 80 are pre-loaded needle 52 to use device is deployed. T形凸片锚定器被一个接一个的堆叠在针的远端上。 T-Tag anchors are stacked one after another on the distal end of the needle. 从T形凸片锚定器上延伸的缝线长度84经由缝线凸片298被保持在钉仓内部的缝线腔94中。 T-shaped tabs extending from the suture anchor suture length 84 lug 298 is held in the interior of the cartridge chamber 94 via sutures. 缝线的松弛末端86从缝线腔94的远端穿出，如图57中所示。 The loose ends of the suture 86 from the distal end of the suture cavity 94 of piercing, as shown in Figure 57. 在该实施方式中，第二推杆292 (在图56中示出）位于针52内。 In this embodiment, the second push rod 292 (shown in FIG. 56) located within the needle 52. 第二推杆292延伸通过在第二T形凸片锚定器80的近端和钉仓32的近端之间的针内腔。 The second push rod 292 extends through the needle lumen between the second T-Tag anchor and the proximal end 80 of the proximal end of the cartridge 32.. 还是在该实施方式中，与前面的实施方式相似的抵抗弹簧296 可连接在扳机26和手枪式握把24之间。 Also in this embodiment, similar to the previous embodiment, the resistance of the spring 296 may be connected between the trigger 26 and pistol grip 24. 如上所述，抵抗弹簧296 在扳机26朝向手枪式握把完全旋转的时候接触到手枪式握把24。 As described above, the trigger 26 against the spring 296 toward the pistol grip when exposed to full rotation pistol grip 24. 当抵抗弹簧296在扳机26和手枪式握把24之间被压缩时，弹簧提供T形凸片锚定器展开的触觉反馈。 When the resistance of the spring 296 is compressed between the trigger 26 and pistol grip 24, the spring provides T-Tag anchor deployment of tactile feedback. 如前面实施方式中的那样， 存在多种提供触觉反馈的方法并且可互换使用。 As described in the previous embodiment above, there are a variety of methods to provide tactile feedback and are used interchangeably.
当钉仓通过任何上述的方法加载到壳体30的远端上时，壳体中推杆140的远端与钉仓中第二推杆292的近端对准。 When the cartridge is loaded into the case by any of the above methods on a distal end 30, the housing 140 of the distal end of the pusher and the staple cartridge 292 is aligned with the proximal end of the second pusher. 图58示出了推杆在展开装置壳体和钉仓之间的对准情况。 Figure 58 shows the alignment of the putter in the expanded device between the housing and the cartridge. 为了展开T形凸片锚定器，外部护套290被部分缩回，如图54中所示，进而暴露出针52。 To deploy a T-Tag anchor, outer sheath 290 is partially retracted, as shown in FIG. 54, thereby exposing the needle 52. 然后将暴露出的针插入组织的用于锚定器的期望部位（未示出）。 The exposed needle is then inserted into the tissue for anchoring the desired location (not shown). 针52穿透了组织，扳机26被手动地向手枪式握把24挤压。 Needle 52 penetrates the tissue, trigger 26 is squeezed to the pistol grip 24 manually. 当扳机26枢转时，扳机向手柄内的驱动爪160施加使驱动爪向远侧前进的作用力。 When the trigger 26 pivots, the trigger is applied to the handle so that the drive pawl driving force pawl 160 distally forward. 当驱动爪160前进时，驱动爪向推杆驱动器154上的远侧齿施加也使推杆驱动器前进的作用力。 When the drive pawl 160 advances, the drive pawl is applied to the distal tooth on push rod driver 154 also forces the plunger drive forward. 推杆140 的近端被连接到推杆驱动器154内（正如在前的实施方式中），因此推杆驱动器的远侧运动使推杆从壳体推进针52。 The proximal end of the push rod 140 is connected to the push rod driver 154 (as in the previous embodiment), and therefore movement of the push rod driver distally advancing the push rod pin 52 from the housing. 当推杆140前进到针52中时，推杆驱使第二推杆292在针内向前。 When the rod 140 to advance to the needle 52, the second push rod 292 push rod driven forward within the needle. 对于扳机26的每次挤压，驱动爪160和推杆驱动器154将推杆140向前推动与T形凸片锚定器长度相等的距离。 For each squeeze of the trigger 26, the drive pawl 160 and push rod driver 154 to move forward with the plunger 140 T-Tag anchor equal length distance. 因此，推杆140 (其从壳体30延伸）将钉仓中的第二推杆292推入钉仓中，其推入距离足 Thus, the push rod 140 (which extends from the housing 30) in the second cartridge pusher 292 is pushed into the staple cartridge, push it away from the foot
37够将第一T形凸片锚定器弹出针尖。 37 reach the first T-Tag anchor pop-up tip. 当T形凸片锚定器展开时， When the T-Tag anchor is deployed,
抵抗弹簧296接触到手枪式握把24。 Resistance spring 296 contacts pistol grip 24. 超过该点对扳机持续的挤压因而就需要额外的压力，对外科医生发出T形凸片锚定器已经展开并且扳机可被释放的信号。 Beyond this point the trigger continuous extrusion thus requires additional pressure on surgeons to issue T-Tag anchor has been launched and the signal trigger can be released. 在扳机26上的压力释放之后，扳机在驱动爪弹簧174的力的作用下枢转回起始位置。 After the pressure on trigger 26 is released, the trigger force of the spring in the drive pawl 174 pivots back to the starting position of the role. 当扳机26枢转回去时，驱动爪160也以上述的方式回到其在手柄中的轨道220 内的起始位置。 When the trigger 26 pivots back, drive pawl 160 in the manner described above also returns to its starting position within track 220 in the handle. 推杆驱动器154由于接触止回爪182而保持前进。 Push rod driver 154 due to exposure to anti-backup pawl 182 is held forward. 再次挤压扳机时，驱动爪160就向第二（近侧的）推杆驱动器齿施加使推杆140再次前进到针52内的第二推杆292上的作用力。 When squeezed the trigger again, drive pawl 160 is applied to the push rod 140 to advance again to force a second push rod 292 pin 52 on the second (proximal) push rod driver tooth. 推杆140将第二推杆292向远侧驱动足够将第二T形凸片锚定器弹出针52的距离。 The second push rod 292 push rod 140 distally sufficient to drive the second T-Tag anchor from the pop pin 52. 在第二T形凸片锚定器被展开后，装置可被复位，通过完全枢转的扳机26撞到手枪式握把24 (抵抗着弹簧296的阻力）将推杆驱动器154复位回到其初始位置，以图31 中所示和对于第一种实施方式上面所述的相同方式。 After the second T-Tag anchor is deployed, the device can be reset by fully pivoting trigger 26 hit pistol grip 24 (resistance of the spring 296 of resistance) would push rod driver 154 is reset back to its initial position, in the same manner and according to a first embodiment shown in FIG. 31 for the above. 在展开装置被复位之后，按钮132向远侧前进从而将外护套290拉回超过针52的尖，如图53中所示。 After deploying device is reset, button 132 is advanced distally so that the outer sheath 290 back over the tip of the needle 52, as shown in FIG. 53. 外护套290的远端放在足够接近第二组织锚定器的区域中的组织上，从而提供抵抗缝线收紧的阻力。 The distal end of the outer sheath 290 is placed close enough to the second tissue anchor of tissue in the region, so as to provide resistance to resist suture tightening. 为了收紧缝线，缝线末端86在沿着壳体30的长度方向上被拉向近侧。 In order to tighten the suture, suture end 86 of the housing 30 along the longitudinal direction of the pulled proximally. 有了外护套290的远端提供的阻力，由于对折的缝线84在尺寸上变短使得组织锚定器收紧在一起。 With resistance distal outer sheath 290 provided, because of the doubled suture 84 is shorter in size so that the tissue anchors is cinched together. 在收紧后，从结82上延伸的缝线93接着可用装置本身、抓紧器或其他类似工具手动地拉进位于外护套290的末端的凹口294中，以切断缝线的松弛末端。 After tightening, extending from the junction 82 of the suture 93 is then available for the device itself, a grasper or other similar tool manually pulled into the outer sheath 290 is located at the end of the recess 294 in order to cut off the loose ends of the suture. 在缝线被切断之后，装置可从套管针上去除。 After the suture is severed, the device can be removed from the trocar. 在装置被去除之后， 按钮132向近侧缩回从而暴露出钉仓联接构件，如图55中所示。 After the device is removed, button 132 is retracted proximally to expose the cartridge coupling member 55 as shown in FIG. 用过的钉仓之后可以从展开装置上去除，并且用新的钉仓替换进而继续手术。 After the spent cartridge can be removed from the expansion device, and further to continue the procedure to replace with a new cartridge.
有许多手术，其中软组织比如但不限于胃肠管道内的組织被靠近。 There are a lot of surgery, including soft tissue such as, but not limited to the gastrointestinal duct tissue is near. 所述的装置可能具有对于软組织对合的有益应用的实例包括对各种不同的瘘管、穿孔、造口、或有意的穿过切割的闭合， 为组织操纵产生的临时或持续的悬吊，以及对为了其他目的而产生的对人造线的加固。 Means for soft tissue may have beneficial applications for instance include cooperation on a variety of fistula, perforation, stoma, or deliberately cut through the closure, temporary or sustained suspension of tissue manipulation produced, and reinforcement of the artificial line for other purposes generated. 如上所述，紧固件展开装置示例性的应用 As described above, the exemplary application of the fastener deploying device
是用在腹腔镜GVR手术中。 GVR is used in laparoscopic surgery. 图59是GVR术中患者的等比例视图，其中通过使用腹腔镜-内窥镜混合手术在胃腔壁上形成皱襞。 Figure 59 is an isometric view of the GVR surgery patients, including through the use of laparoscopic - endoscopic surgery hybrid formed in the stomach cavity wall folds. 在混合手术中，通过将柔顺的内窥镜402通过食管穿进胃腔404 内部实现了对一个或多个皱襞部位的可视化。 In the mixing operation, by the compliant endoscope 402 through the esophagus into the stomach cavity 404 through the internal implementation of one or more folds site visualization. 内窥镜402提供了对胃腔404的吹气、照明以及可一见化，以及作为进入腔内的通路。 Endoscope 402 provides a blow to the stomach cavity 404, and a saw of lighting, as well as a passage into the cavity. 胃腔404通过内窥镜402被吹气以便产生足够坚硬的工作表面， 其可以不损伤腔的相对侧壁而被刺穿。 Gastric cavity 404 through the endoscope 402 is sufficient to produce a hard blow work surface, which may damage not opposite side walls of the cavity is pierced. 对胃腔进行吹气也使得腔边界和期望皱襞的部位可以用腹部外的触诊绘制出来。 Gastric cavity also allows the boundaries and expectations of blowing the folds of the outer portion of the abdominal cavity can be drawn palpation.
胃腔404已经通过内窺镜402进行绘制，如果需要的话腹腔也被吹完气了之后，套管针被插入腹壁以形成到腹膜腔的通路。 Gastric cavity 404 has been drawn through the endoscope 402, if desired, after the abdominal cavity after the gas has been blown, the trocar is inserted into the abdominal wall to form a passage to the peritoneal cavity. 图60示出了通过腹壁410中的切口插入的套管针406。 Figure 60 shows a cut through the abdominal wall 410 of the trocar 406 is inserted. 套管针406 在腹壁410中到位时，本发明的紧固件展开装置20可穿过套管针并进入腹膜腔412。 Trocar 406 410 in place in the abdominal wall, the fastener deploying device 20 of the present invention may be passed through the trocar and into the peritoneal cavity 412. 在腹膜腔内，钉仓32的远端被压到腔的前壁上以便探查腔的外部表面。 In the peritoneal cavity, the distal end of the cartridge 32 is pressed into the cavity to probe the outside surface of the front wall of the chamber. 在探查腔壁时，针52被缩回进钉仓32 (在第一到第三种实施方式中）或由外护套290覆盖（在第四种实施方式中）。 When probing the cavity wall, needle 52 is retracted into the cartridge 32 (in the first to third embodiments) or covered by the outer sheath 290 (in the fourth embodiment). 腔壁的锯齿形切口可通过内窥镜看到以便确定插入针52的恰当部位。 Cavity wall zigzag incision can be seen in order to determine the proper insertion of the needle portion 52 through the endoscope. 腹腔镜可视化可用于辅助或替换内窥镜观察从而确定恰当部位。 Laparoscopic visualization may be used to assist or replace the endoscopic observation to determine the appropriate site. 在恰当的插入部位已经决定之后，按钮132 沿着手柄顶部滑动以便暴露出针52。 After the proper insertion site have decided that the button 132 to slide along the top of the handle to expose the needle 52. 如果是上述的第四种实施方式中的情况，按钮132向近侧滑动以缩回外部保护性护套290而远离暴露出的针尖。 If the above-described fourth embodiment, the slide button 132 to retract the outer protective sheath 290 away from the exposed needle tip proximally. 之后，前腔壁414被针尖刺穿到达胃腔内部。 After that, the anterior tip 414 is pierced reach the stomach cavity. 针52被足够防止针掠过前腔壁的外部表面的作用力插入到腔404 中。 Pin 52 is sufficient to prevent passing the anterior forces pin inserted into the external surface of the cavity 404. 在针52位于胃腔内时，装置扳机被挤压，以将第一T形凸片锚定器展开进入或通过腔壁，以任何上述的方式。 The needle 52 is located in the gastric cavity, the device trigger is squeezed to the first T-Tag anchor is deployed into or through the cavity wall, in any manner described above.
在第一T形凸片锚定器被展开进入腔404中之后，针52从腔中去除。 After the first T-Tag anchor is deployed into the cavity 404, needle 52 is removed from the chamber. 在优选的情况下，缝线环70在针52被去除时紧紧地围 In the preferred case, the suture loop 70 tightly around the needle 52 is removed
绕着对折的缝线84的缝线，部分缝线保持在腔壁内。 Fold the suture around the suture 84, part of the suture retained within the cavity wall. 替代地，如果缝线环70足够大，当针52被去除时，缝线环从第一T形凸片锚定器74上被拉回通过腔壁。 Alternatively, if suture loop 70 is sufficiently large, when the needle 52 is removed, the suture loop from the first T-Tag anchor is drawn back through the cavity wall 74. 在针52被从腔404中去除之后， 钉仓32 (或保护性护套290)被拉回越过针尖。 After the needle 52 is removed from the cavity 404, cartridge 32 (or protective sheath 290) is drawn back over the tip. 再次用钉仓远端探查前壁，如图61中所示，以便确定出第二T形凸片锚定器的部位。 Again with the distal end of the probe cartridge front wall, as shown in FIG. 61, in order to determine the second T-Tag anchor site. 一旦恰当的放置部位被确定了，针52就再次被暴露并通过前壁414插入胃腔404。 Once proper placement portion is determined, needle 52 and 414 was exposed again inserted through the anterior wall of the gastric cavity 404. 针52位于胃腔404内时，预先结好的第二T形凸片锚定器80就展开进入腔的内部。 Pin 52 is located inside the stomach cavity 404, pre-knot good second T-Tag anchor 80 to expand access to the interior cavity.
在第二T形凸片锚定器80被展开之后，针52从前壁414中去除，从而将连接的缝线84通过壁拉回。 In the second T-Tag anchor 80 is deployed later, the needle 52 is removed from the front wall 414, so that the suture 84 is connected through a back wall. 在两个T形凸片锚定器通过腔壁展开时，缝线抓紧构件200被缩回（在上述的开始的两个实施方式中）以便向缝线84施加张力。 When the two T-Tag anchor through the cavity wall to expand, suture grasping member 200 is retracted (in the two embodiments described above in the beginning) to apply tension to the suture 84. 当张力被施加到缝线上时，组织被拉到一起并且朝着展开装置，这是由于缝线的松弛末端被保持在钉仓内。 When the tension is applied to the suture, the tissue is drawn together and towards the deploying device, which is due to loose ends of the suture is held within the cartridge. 缝线86的松弛末端穿过在钉仓和壳体之间的侧缝线开口282 (正如上述的第三种实施方式中那样），或穿出钉仓32的远端（正如上述的第四种实施方式中那样），缝线可用手或用外科器械比如抓紧器被手动张紧，以便拉住缝线。 Loose ends of the suture 86 passes through between the cartridge and the housing of the side seam opening 282 (as described above as in the third embodiment), or piercing the cartridge distal end 32 (as described above fourth Species embodiment do), the suture can be hand or with a surgical instrument such as a grasper is manually tensioned to pull the suture. 在装置的第三种实施方式中，手动拉住缝线末端86会将胃壁拉到与钉仓的远端接触。 In a third embodiment of the apparatus, manually pulling suture end 86 will be pulled into contact with the stomach wall of the distal end of the cartridge. 如前两种实施方式，这里提供的阻力允许组织锚定器被收紧在一起。 As the first two embodiment, the resistance provided herein allows the tissue anchors are cinched together. 然而，在装置的第四种实施方式中，保护性护套的远端被压到前腔壁上来提供在收紧和切割过程中的阻力。 However, in the fourth embodiment of the device, the protective sheath is pushed to the anterior distal provide resistance to tighten up and cutting process. 钉仓或护套尖的额外的阻力是必需的，这是由于T形凸片锚定器和缝线两者都从展开装置脱开，从而在前三种实施方式的情况下能够阻止装置施加阻力。 Cartridge or additional drag sheath tip is necessary, which is due to both T-Tag anchors and suture are disengaged from the expansion, thus the case of the former three embodiments can be applied to prevent the device resistance.
当缝线张紧以便缩短对折缝线的长度84的尺寸时，T形凸片锚定器74, 80被拉到一起，置于围绕着每个T形凸片锚定器的浆膜组织附近。 When the suture tensioning in order to reduce the size of the length of the crease line 84 when, T-Tag anchors 74, 80 are drawn together, placed near surrounding each T-Tag anchor serosal tissue . 在T形凸片锚定器和连接的缝线已经用于放在腔壁 In the T-Tag anchors and suture connections it has been used on the cavity wall
40附近，剩余的缝线长度被调整进入到钉仓上的切割构件或，替代地，进入到外护套上的切割凹口。 Near 40, the remaining suture length is adjusted into the cutting member on the cartridge or, alternatively, into the cutting notch on the outer sheath. 有了从展开装置无论内部还是外部而来施加到缝线近端的松弛末端上的张力，装置被拉回远离T形凸片锚定器，以便将缝线张紧到刃边并且切断缝线。 Have come from, whether internal or external expansion device is applied to the loose end of the suture tension on the proximal end of the device is pulled back away from the T-Tag anchor to the suture tensioning and cutting edge to edge stitching . 切断之后，展开装置和连接的钉仓通过套管针被撤回，而剩余长度的缝线保留在钉仓内。 After cutting, expansion means and attached cartridge are withdrawn through the trocar, and the remaining length of suture retained within the cartridge. 替代地，在第三种和第四种实施方式的情况下， 展开装置从腹膜腔去除，并且松弛的缝线末端86后来被抓紧器或 Alternatively, in the case of the third and fourth embodiments, the deploying device is removed from the peritoneal cavity, and the loose suture end 86 or later graspers
其他外科工具通过套管针撤回。 Other surgical instruments through the trocar withdrawn. 图63示出了胃腔404,其中T形凸片锚定器74, 80被滑动结82收紧并锁定在一起，以便放置在胃腔壁外部的浆膜层附近并形成皱襞416。 Figure 63 shows gastric cavity 404, including T-Tag anchors 74, 80 slip knot 82 is tightened and locked together, to be placed near the gastric cavity wall and form a fold serous layer 416.
如图63中概略地所示， 一个或多个用附图标记420标识的额外的紧固件可在GVR术中沿着腔壁展开。 Schematically shown in FIG. 63, one or more additional fasteners by reference numeral 420 in the GVR procedure can be identified expand along the cavity wall. 套管针可在腹壁内弯折，或（如果需要的话）在腹壁内去除并重置，以便达到所有期望的紧固件部位。 The trocar can be bent in the abdominal wall, or (if desired) be removed and reset in the abdominal wall, in order to reach all of the desired fastener portion. 缝线材料是在每个紧固件中的T形凸片锚定器之间收紧在一起，以便在腔壁皱襞416的长度上延伸，如图63和64中所示。 Each fastener suture material is cinched together between the anchor tabs T-shaped, so that the cavity wall fold 416 extends the length of, 63 and 64 as shown in FIG. 用于形成皱襞的紧固件的数量取决于期望的皱襞长度和紧固件之间的期望的间隔。 The desired interval number for forming folds of fasteners depending on the desired length and folds between fasteners. 优选地，每个紧固件沿着期望的皱 Preferably, each fastener along a desired wrinkle
襞线的长度均匀地间隔开。 The length of the fold line of evenly spaced. 同样地，在每个紧固件内，T形凸片锚定器优选地横贯皱襞线均勻地隔开，因此优选地形成了均匀的组织铍襞而不会发生扭曲或聚束现象。 Likewise, within each fastener, T-Tag anchors are preferably spaced across the crease fold line evenly, it is preferable to form a homogeneous organization and beryllium fold without distortion or bunching. 缝线锚定装置适当的相对间隔可通过内窥镜确定。 Proper relative spacing of the suture anchoring devices can be determined through the endoscope. 替代地，额外的套管针可插入腹壁中并与光学用具结合使用，从而可见地通过腹腔镜确定缝线锚定装置恰当的位置。 Alternatively, an additional trocar may be inserted into the abdominal wall and used in conjunction with an optical appliance, which can be seen to determine the position of the suture anchoring devices laparoscopically appropriate.
前述的对本发明优选实施方式的介绍是为了解释和说明而提出的。 The foregoing description of the preferred embodiment of the present invention is to explain and illustrate proposed. 意图并不是要穷举或限定本发明到公开的精确形式。 Intention is not intended to be exhaustive or to limit the invention to the precise form disclosed. 显而易见的修改或变化在上述教导下是有可能的。 Obvious modifications or variations of the above teachings is possible. 所选的和介绍的实施方式是为了最好的解释本发明的原理及其实际应用，从而使得本领域的普通技术人员能够以各种实施方式中和适于特定可预想到的用途的各种改变来利用本发明。 Selected and described embodiment of the principles and their practical application to the best explanation of the invention, so that one of ordinary skill in the art can be adapted for various embodiments and can be expected to use the particular variety change to take advantage of the present invention. 本发明的范围通过在此所附的权利要求书限定。 The scope of the invention by the appended claims this limitation.
|Cooperative Classification||A61B17/0467, A61B17/0469, A61B2017/00818, A61B2017/0417, A61B2017/0416, A61B2017/0409|
|22 Jul 2009||C06||Publication|
|29 Dec 2010||C10||Request of examination as to substance|
|16 Jan 2013||C02||Deemed withdrawal of patent application after publication (patent law 2001)|