CN101528146B - 外科手术封闭和切割器械 - Google Patents
外科手术封闭和切割器械 Download PDFInfo
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Abstract
一种用于封闭和切割组织的电外科手术器械包括镊子和电源。镊子包括围绕销枢轴转动的夹爪和设置在夹爪之间的至少一个刀片。一轴使手柄与夹爪连接,用于使夹爪移动,同时还通过夹爪传导来自电源的电流。丝线穿过轴和销中的孔,使杆连接至刀片,以使刀片移动。在双极结构中,丝线还通过刀片传导电流。
Description
本专利申请要求于2006年7月13日申请的美国临时专利申请US60/830,442的优先权和全部权益,其整个说明书特意在此作为参照引入。
技术领域
本申请总体上涉及使用电流和刀片切割和凝结组织的外科手术器械。
背景技术
内窥镜外科手术,也称为最低限度侵入外科手术,是设计用于将患者的不适减小到最低程度的外科手术方法。这一点通过将进入身体内部器官所需开口的必要尺寸减小为小孔来实现。典型的结果是:较少创伤、较少痛苦、较快痊愈时间以及如果有的话较短的住院治疗时间。优势在于并发症的减少、死亡率的减小以及对于患者和保险公司而言相当可观的费用节约。
身体内腔的内窥镜接入通常是通过使用套管和套管针来实现的。由外科手术刀片或锋利的套管针刺破皮肤、脂肪和肌肉组织。用附有套管的套管针对体腔的穿透建立起临时性入口或工作通道。移除套管针并将套管留在身体内部使得观测器、照相机、镊子和其它附件能够进入体腔以执行外科手术程序。
内窥镜外科手术程序包括大部分的抓持、烧灼和解剖或剪切步骤,以分开腱、肌肉和血管。封闭被切割或解剖的部分是防止出血所必须的。在许多情形中,这一点通常通过利用组织和血管的电烧灼或热凝结来完成。抓持器和/或解剖器施加电流到切割区,接着利用弯的或直的剪刀进行解剖,在执行切割的同时进行电烧灼。
出于减轻患者痛苦和减少患者身上疤痕的目的以及为了通过节约额外套管和套管针的使用来减少成本,非常需要将内窥镜外科手术程序中的开口数量减少到最小的程度。这一点可通过将抓持、烧灼和解剖结合到一个工具中来完成。由于抓持器或剪刀不再需要单独的开口,这样就减少了开口的数量。这样的优势是明显的:较少的开口、较少的疤痕、较少的痛苦、较少的并发症以及对套管针-套管、单功能工具和手术时间而言较少的成本。
现有技术中有许多用于封闭和切割组织的电外科手术工具。Feinberg等人的美国专利US5,458,598(’598专利)公开了一种这类的工具。’598专利中的工具包括具有一对夹爪的镊子。通过夹爪在迫使它们合拢的管子中的延伸和缩回来打开和闭合夹爪。产生电流的电源包括一对馈电器(feed),一个馈电器连接一个夹爪。在操作中,电流从一个夹爪经过组织流向另一个夹爪。一片单刀片位于夹爪之间并且可纵向移动以切割组织。
尽管’598专利中的工具是实用的,但对于外科手术器械而言仍然存在提供更有效的电流应用和对操作该器械的外科医生提供更大触觉反应的机会。
发明内容
本发明提供一种用于切割组织的外科手术器械。该器械包括具有第一馈电器和第二馈电器的电源,用于在第一馈电器和第二馈电器之间供应电流。一对夹爪与第一馈电器电连接,用于抓持组织且将电流施加到该组织。至少一个手柄与夹爪操作性连接,以致动夹爪中的至少一个。在夹爪之间设置刀片,杆与该刀片操作性连接,用于使该刀片移动,以对组织进行切割。该刀片还与第二馈电器电连接,以将电流供应到组织。
本发明还提供包括具有近端和远端的管子的外科手术器械。具有近端和远端的U形夹部件在该U形夹部件的近端处由管子的远端支撑。U形夹部件限定了从远端向内延伸且使一对腿分开的槽口。通过 所述腿中的每条腿限定U形夹孔,且U形夹销被设置成沿纵向通过U形夹孔。U形夹销能以铰链形式支撑这对夹爪。与刀片和杆操作性连接的丝线,用于响应该杆的移动而使刀片移动。U形夹销限定了横向延伸通过U形夹销的U形夹销孔,其中丝线被设置成通过该U形夹销孔。
通过接通夹爪和刀片之间的电路,将电流以双极方式施加到组织。由于电流流经每个夹爪,因此这种施加可称为“三极的”。这样使电流更为有效、平均地施加到组织上。
而且,夹爪不再与管子在闭合位置摩擦接合。这样给外科医生提供了更有效的触觉响应,使外科医生能够感觉到夹爪与组织的接合。
附图说明
在参考下面结合附图的详细描述来更好地理解本发明时,人们将很容易认识到本发明的其它优势,其中:
图1是显示了镊子和电源的外科手术器械第一实施例的透视图;
图2是显示了打开位置中的一对夹爪和缩回位置中的刀片的镊子夹爪组件的侧视图;
图3是显示了闭合位置中的夹爪和延伸位置中的刀片的夹爪组件的侧视图;
图4是显示了抓持血管的夹爪的镊子的局部透视图;
图5是镊子夹爪组件的局部分解图;
图6是显示了旋转夹爪的旋钮、致动夹爪的手柄和致动刀片的杆的镊子的局部侧面剖视图;
图7是一部分夹爪组件的局部透视图;
图8是可移动手柄的透视图;
图9是使可移动手柄与杆匹配的连接块的透视图;
图10是连接块的正视图;
图11是连接块的侧面剖视图;
图12是与连接块匹配的杆的侧面剖视图;
图13是显示了在旋钮和将旋钮锁定就位的球塞之间的接触面的局部剖视图;
图14是球塞的透视图;
图15是外科手术器械第二实施例的透视图;
图16是夹爪位于打开位置的第二实施例的夹爪组件的侧视图;
图17是夹爪位于闭合位置的第二实施例的夹爪组件的侧视图;
图18是显示了容纳刀片的通道的夹爪中的一个的内部视图;
图19是第二实施例的夹爪组件的局部侧面剖视图;
图20是显示了丝线通过销的路径的夹爪组件的局部底面剖视图;
图21是外科手术器械第三实施例的透视图;
图22是刀片位于打开位置中的第三实施例的夹爪组件的侧视图;
图23是刀片位于闭合位置中的第二实施例的夹爪组件的侧视图;
图24是抓持和切割血管的第三实施例的夹爪组件的透视图;
图25是第三实施例的镊子的局部分解图;
图26是位于打开位置中的第三实施例的刀片的局部透视图;
图27是位于闭合位置中的第三实施例的刀片的局部透视图。
具体实施方式
参照附图,其中整个附图中相同的附图标记表示相应的部件,附图示出了切割和/或封闭组织的外科手术器械50。
参照图1,器械50包括镊子52和供应电流到镊子52的电源54。具体而言,电源54包括与镊子52电连接的第一馈电器56和第二馈电器58。电源54优选产生在射频(RF)的交变电流。产生用于外科手术程序的RF电流是本领域技术人员所熟知的。此外,第一馈电器56或第二馈电器58可以是“热的(hot)”或“正的”馈电器,而交流馈电器是“中性的”或“负的”馈电器。
镊子52包括夹爪组件(未标记)。夹爪组件包括一对夹爪60、62。 夹爪60、62可在如图2所示的打开位置和如图3所示的抓持组织的闭合位置之间移动。如图3中所能看到的,夹爪60、62在闭合位置中不需要彼此接触。参照图4,夹爪60、62理想地适于抓持血管63。但是,本领域技术人员也了解可由夹爪60、62抓持其它形式的组织。在所示实施例中,夹爪60、62均可相对彼此移动。但是,也可以构想替代的实施例使夹爪60、62中的一个是不动的而另一个夹爪62、60是可移动的。
参照图1,夹爪60、62中的至少一个与电源54的第一馈电器56电连接以将电流施加到组织上。优选夹爪60、62均与第一馈电器56电连接,使得每个夹爪60、62上的电势在任何时候都大体相同。下面详细描述优选的从电源54向夹爪60、62传送电流的技术。
镊子52包括与夹爪60、62操作性连接的至少一个手柄64、66,以致动即移动夹爪60、62中的至少一个。优选固定手柄64保持不动,而可移动手柄66可相对固定手柄64移动。夹爪60、62的移动与手柄66的移动相对应。具体而言,优选当手柄64、66彼此最靠近时,夹爪60、62处在闭合位置,或者相反。
参照图5和6,轴68包括近端70和远端72。轴68将夹爪60、62操作性连接至可移动手柄66。优选轴68大体是圆柱形的,具有圆形截面。但是,本领域技术人员也可采用其它用于轴68的合适形状。
具有近端76和远端78的管子74至少部分围绕轴68。管子74的近端76与固定手柄64连接并由该固定手柄64支撑。管子74优选是圆筒形的,但其它合适的形状也是本领域技术人员所了解的。
具体参照图5,镊子52包括具有近端82和远端84的U形夹部件80。U形夹部件80优选具有大体圆筒形的形状,由管子74支撑。在所示的实施例中,U形夹部件80限定了凹进面86。凹进面86具有将管子74的远端78安装在其内部,也即与管子74的远端78相匹配的尺寸。可利用粘合剂、焊接、铜焊、定位螺钉(未示出)或其它技术将凹进面86紧固在管子74中。
U形夹部件80限定了从远端84向内延伸的槽口88。槽口88将 一部分U形夹部件80分成一对腿90。U形夹部件80还限定了穿过每条腿90横向延伸的U形夹孔92。U形夹部件80还限定了从近端82延伸到槽口88的管93。轴68通过管93延伸到U形夹部件80中。
U形夹销94通过U形夹孔92沿纵向设置。U形夹销94还延伸通过夹爪60、62中的孔(未标记),从而以铰链形式支撑夹爪60、62。所述另一方式是,夹爪60、62围绕U形夹销94在打开位置和闭合位置之间移动。如可在图1-4中看到的,至少一部分夹爪60、62被设置在槽口88中。联杆96与每个夹爪60、62附接,同时优选在联杆96和夹爪60、62中具有销(未标记)和孔(未标记),如在图2和5中很容易能够看到的。U形夹销94、联杆96和夹爪60、62之间连接的细节图示可在图7中看到。
再次参照图5,轴孔98邻近轴68的远端72设置。轴68的远端72优选限定了用于与扁平联杆96匹配的扁平部分(未标记)。轴销100使轴68与联杆96相互连接。轴销100大体是圆柱形的且包括中心段102和两个端段104。中心段102具有与轴孔98匹配的尺寸,而端段104具有与联杆96中的孔(未标记)匹配的尺寸。
上述夹爪组件给执行手术程序的外科医生提供很好的触觉。具体而言,由于夹爪60、62不像在许多现有技术镊子52中所做的那样被拉入管子或壳体内,因此外科医生能够更好地感觉夹爪60、62与组织接触的摩擦,而不是夹爪60、62与管子或壳体接触的摩擦。
优选电流经由轴68传导到夹爪60、62。因而,轴68至少部分由导电材料(例如但不限于金属)形成。为了便于制造,优选整个轴68由金属形成并且包覆有绝缘层(未标记),以在需要的地方提供电绝缘。金属优选是不锈钢,但其它合适的金属也是本领域技术人员公知的。联杆96和各种销也由导电材料(例如金属)形成,以将电流从轴传导到夹爪60、62。电源54的第一馈电器56经由电缆(未标记)与轴68在其近端70处电连接。如下所述,连接件105使电缆与轴68电连接。
镊子52还包括用于切割组织的至少一个刀片106。具体地,刀片106包括至少一个锋利的刀刃(未标记),用于切割由夹爪60、62保 持就位的组织。第一和第二实施例中的刀片106可相对管子74以往复的形式来回移动。
在本发明的第一实施例和第二实施例中,在夹爪60、62之间设置单刀片106。在每个夹爪60、62中限定通道61、63,以容纳刀片106,特别是当夹爪60、62位于闭合位置中时。
杆108与刀片106操作性连接以移动刀片106。在第一实施例中,丝线110操作性连接在刀片106和杆108之间并且响应杆108的移动而移动刀片106。丝线110优选是由金属形成的刚性部件。但是,本领域技术人员也可采用其它合适的替代物用于执行丝线110的功能。
轴68限定沿纵向设置在轴68的端部70、72之间的中空管道112。具有中空中心且优选由塑料形成的管腔113可设置在全部或部分管道112中。轴销100还限定横向延伸通过中心段102的孔114。此外,U形夹销94限定沿横向延伸的孔116。丝线110穿过管道112、管腔113、轴销100的孔114和U形夹销94的孔116。丝线110优选通过焊接或铜焊与刀片106连接。管腔113为管道112提供刚性并且使丝线110易于经过其被引导。
再次参照图1,可移动手柄66包括U形夹顶部118。U形夹顶部118接收并保持连接块120。现在参照图8,U形夹顶部118大体是块状的并且限定块管腔122和块销腔124。如图9-11所示,连接块120包括块部分126和从块部分126延伸的块管128。块部分126和部分块管128插在块管腔122内。块管128包括一对块销130,块销130插在U形夹顶部118的块销腔124内,以阻止连接块120相对固定手柄64旋转。
如图12所示,杆108可滑动地设置在限定于块管128中的管膛132中。丝线110经由刀片丝线紧固定位螺钉134与杆108连接。如在图6中得到的最佳观察结果,压缩弹簧136设置在管膛132内并在连接块120和杆108之间施加偏压。当向着夹爪60、62推杆108时,丝线110使刀片106向前移动,从而对已抓持在夹爪60、62之间的组织进行解剖。压缩弹簧136不仅在推杆108时产生阻力,而且在杆108 被释放后使刀片106返回到缩回位置,也即,最接近夹爪60、62近端的位置。因此,按压杆108,向远端推动丝线110,将刀片106向前传送,以便对已抓持在夹爪60、62之间的组织进行解剖。杆108在管膛132内克服弹簧136的作用自由地前后移动。再次参照图12,杆108还限定了凹槽137。定位螺钉138延伸通过块管128并限制杆108向后的移动,以避免不希望出现的与块120的分离。
参照图1、6和13,旋钮140优选邻近管子74的近端76围绕管子74。旋钮140优选经由定位螺钉142与管子74附接;但是,也可以利用其它连接技术。旋钮140延伸到固定手柄64中并且可在该固定手柄64中旋转。旋钮140限定了一固定手柄腔144,该固定手柄腔144围绕该旋钮140的外表面被限定。腔144设置在固定手柄64的内部。图14详细描绘了球塞146,优选其包覆有绝缘层。再次参照图6和13,球塞146被安装到固定手柄64上,球塞146的球(未标记)延伸入腔144,以将旋钮140保持在固定手柄63内。因为管子74经由U形夹部件80与夹爪60、62连接,所以当旋钮140相对固定手柄64旋转时,夹爪60、62也旋转。
在第一实施例中,器械50以单极模式作用。具体而言,传导垫148与电源54的第二馈电器58电连接。在器械50的操作过程中,放置传导垫148使其接触患者皮肤。从而,从第一馈电器56通过夹爪60、62,通过患者组织,通过传导垫148,经由第二馈电器58返回电源54形成传导电流的电路。
在第二实施例中,如图15所示,器械50以双极模式作用。具体而言,刀片106与电源54的第二馈电器58电连接,将电流施加到组织。因此,电路通过夹爪60、62和刀片106之间的组织形成。RF能量通过凝结血液和使组织易于用刀片106切割来协助组织的处理。当组织是血管时,血液的这种凝结帮助在切割之前和之后封闭血管。丝线110优选由导电材料形成并且与刀片106电连接,以将电流传导到刀片106。
轴68和丝线110彼此电绝缘,从而电流不直接在轴68和丝线110 之间流动。如上所述,丝线110通过限定在轴68中的管道112行进。优选在至少部分丝线110上施加绝缘层(未标记),以使丝线110和轴68电绝缘。本领域技术人员也会采用其它技术对丝线110和轴68进行电绝缘。
在第三实施例中,如图21-27所示,该至少一片刀片由第一刀片150和第二刀片152来实现。第一和第二刀片150、152设置成剪刀形结构。许多第三实施例的部件与关于第一和第二实施例的上述那些部件相似。因此,将仅详细描述有实质区别的部分。
具体参照图25,刀片150、152中的每个刀片限定一个孔(未标记)。U形夹销94被设置成通过刀片150、152的孔以及U形夹孔92和夹爪60、62的孔。刀片150、152设置在夹爪60、62之间。夹爪60、62的通道61、63也可容纳刀片150、152。
叉154从丝线110一端延伸。叉154包括一对钳156,这对钳156带有通过每个钳156设置的孔(未标记)。每个刀片150、152中形成伸长的槽口(未标记)。叉154被设置成通过U形夹销94的孔116。叉154的钳156和刀片150、152的伸长槽口通过销(未标记)连接。
如图6所示,通常通过设置在块元件120中的弹簧136的压缩来向近端推杆108。因此,为了实现刀片150、152的切割,向前推杆108,以使限定在杆108和块元件120之间的缝隙闭合。参照图22、23、26和27,叉156和销在限定于刀片150、152中的槽口内滑动,促使刀片150、152绕U形夹销94枢轴转动并闭合。如上所述,U形夹销94由刀片150、152和夹爪60、62共用。因此当刀片150、152和夹爪60、62每个都绕U形夹销94枢轴转动时,枢转运动是彼此独立的。
重要的是要理解,在不向前推动杆108时,通常经由设置在叉154中的丝线110被弹簧136向后拉动的刀片150、152总是保持在夹爪60、62中。刀片150、152向外的移动受到夹爪60、62近端中闭合部分(未编号)的限制。而且,当手柄64、66被挤压在一起促使夹爪60、62闭合时,刀片150、152被促使闭合而不执行切割。刀片150、152进一步的重合由被U形夹74所保持的横向销94经由限定在剪刀刀片150、152中的槽口88的被迫运动来实现。
本领域技术人员会认识到该实施例对于其它单极应用的适应性,例如单爪工具和弯爪工具,此处剪刀刀片的弯曲将依从于夹爪内的弯曲槽口。
本发明已经以图例方式得到描述,而要理解的是,已使用的术语表示的是描述用语的本意而不具有局限性。根据上述教导,本发明的许多修正和变化都是可能的,并且本发明可以不同于具体描述的方式来实施。
Claims (15)
1.一种用于切割组织的外科手术器械,该外科手术器械包括:
具有第一馈电器和第二馈电器的电源,用于在所述第一馈电器和所述第二馈电器之间供应电流;
与所述第一馈电器电连接的一对夹爪,用于抓持所述组织和将所述电流施加到所述组织;
与所述夹爪操作性连接的至少一个手柄,用于致动所述夹爪中的至少一个;
具有使所述夹爪与所述手柄操作性连接的近端和远端的轴;
所述轴由导电材料形成并且与所述夹爪和所述第一馈电器电连接,用于在所述夹爪和所述电源之间传导所述电流;
所述轴限定在所述轴的所述近端和所述远端之间沿纵向设置的孔;
设置在所述夹爪之间的刀片,所述刀片与所述第二馈电器电连接,用于将所述电流供应到所述组织;
与所述刀片操作性连接的杆,用于使所述刀片移动,以对所述组织进行切割;以及
操作性连接所述刀片和所述杆的丝线。
2.如权利要求1所述的器械,其中所述丝线由导电材料形成并且与所述刀片和所述第二馈电器电连接,以在所述刀片和所述电源之间传导所述电流。
3.如权利要求2所述的器械,其中所述轴和所述丝线彼此电绝缘,使得所述电流不直接在所述轴和所述丝线之间流动。
4.如权利要求3所述的器械,还包括围绕所述丝线的至少部分设置的绝缘层,用于使所述丝线和所述轴电绝缘。
5.一种用于切割组织的外科手术器械,该外科手术器械包括:
具有第一馈电器和第二馈电器的电源,用于在所述第一馈电器和所述第二馈电器之间供应电流;
与所述第一馈电器电连接的一对夹爪,用于抓持所述组织和将所述电流施加到所述组织;
与所述夹爪操作性连接的至少一个手柄,用于致动所述夹爪中的至少一个;
设置在所述夹爪和所述手柄之间的管子,用于在所述夹爪和所述手柄之间提供一定长度;
设置在所述夹爪之间的刀片;
与所述刀片操作性连接的杆,用于使所述刀片移动,以对所述组织进行切割;
所述刀片与所述第二馈电器电连接,用于将所述电流供应到所述组织;以及
具有近端和远端且被所述管子支撑的U形夹部件。
6.如权利要求5所述的器械,其中所述U形夹部件限定从所述U形夹部件的远端向内延伸并且使一对腿分开的槽口,并且限定通过所述腿中的每条腿的U形夹孔。
7.如权利要求6所述的器械,还包括被沿纵向设置成通过所述U形夹孔并且与所述夹爪中的每个夹爪相连接的U形夹销,用于以铰链形式支撑所述夹爪。
8.如权利要求7所述的器械,其中所述U形夹销限定横向延伸通过所述销的U形夹销孔。
9.如权利要求8所述的器械,还包括被设置成通过所述U形夹销孔且操作性连接所述刀片和所述杆的丝线。
10.一种用于切割组织的外科手术器械,该外科手术器械包括:
具有近端和远端的管子;
具有近端和远端的U形夹部件,并且该U形夹部件在所述U形夹部件的近端处由所述管子的所述远端支撑;
所述U形夹部件限定从所述U形夹部件的远端向内延伸且使一对腿分开的槽口,并且该U形夹部件限定通过所述腿中的每条腿的U形夹孔;
被沿纵向设置成通过所述U形夹孔的U形夹销;
能由所述U形夹销以铰链形式支撑并能致动的一对夹爪,用于抓持所述组织;
与所述夹爪操作性连接的至少一个手柄,用于致动所述夹爪中的至少一个;
与所述夹爪相邻设置并能移动的刀片,用于对所述组织进行切割;
用于使所述刀片移动以对所述组织进行切割的杆;
与所述刀片和所述杆操作性连接的丝线,用于响应所述杆的移动而使所述刀片移动;以及
所述U形夹销限定横向延伸通过所述U形夹销的U形夹销孔,其中所述丝线被设置成通过所述U形夹销孔。
11.如权利要求10所述的外科手术器械,还包括具有第一馈电器和第二馈电器的电源,用于在所述第一馈电器和所述第二馈电器之间供应电流。
12.如权利要求11所述的外科手术器械,其中所述第一馈电器与所述夹爪中的至少一个夹爪电连接。
13.如权利要求12所述的外科手术器械,其中所述第一馈电器与所述夹爪中的两个夹爪电连接。
14.如权利要求11所述的外科手术器械,其中所述第二馈电器与一传导垫电连接。
15.如权利要求11所述的外科手术器械,其中所述第二馈电器与所述刀片电连接。
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US7811283B2 (en) | 2003-11-19 | 2010-10-12 | Covidien Ag | Open vessel sealing instrument with hourglass cutting mechanism and over-ratchet safety |
DE102004040959B4 (de) | 2004-08-24 | 2008-12-24 | Erbe Elektromedizin Gmbh | Chirurgisches Instrument |
US7384421B2 (en) | 2004-10-06 | 2008-06-10 | Sherwood Services Ag | Slide-activated cutting assembly |
US20070049928A1 (en) | 2005-02-08 | 2007-03-01 | Fleenor Richard P | Nickel titanium alloy electrosurgery instrument |
US7628791B2 (en) | 2005-08-19 | 2009-12-08 | Covidien Ag | Single action tissue sealer |
EP1767163A1 (en) | 2005-09-22 | 2007-03-28 | Sherwood Services AG | Bipolar forceps with multiple electrode array end effector assembly |
US7722607B2 (en) | 2005-09-30 | 2010-05-25 | Covidien Ag | In-line vessel sealer and divider |
US7766910B2 (en) * | 2006-01-24 | 2010-08-03 | Tyco Healthcare Group Lp | Vessel sealer and divider for large tissue structures |
-
2007
- 2007-07-13 WO PCT/US2007/015930 patent/WO2008008457A2/en active Application Filing
- 2007-07-13 EP EP07810410.6A patent/EP2040634B1/en active Active
- 2007-07-13 CN CN2007800308881A patent/CN101528146B/zh active Active
- 2007-07-13 US US11/777,677 patent/US9585714B2/en active Active
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WO2008008457A3 (en) | 2008-05-22 |
US20080015566A1 (en) | 2008-01-17 |
EP2040634A2 (en) | 2009-04-01 |
US9585714B2 (en) | 2017-03-07 |
EP2040634B1 (en) | 2014-06-11 |
CN101528146A (zh) | 2009-09-09 |
WO2008008457A2 (en) | 2008-01-17 |
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