CN107847244B - 包括可动远侧末端的组织移除导管 - Google Patents

包括可动远侧末端的组织移除导管 Download PDF

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CN107847244B
CN107847244B CN201680042441.5A CN201680042441A CN107847244B CN 107847244 B CN107847244 B CN 107847244B CN 201680042441 A CN201680042441 A CN 201680042441A CN 107847244 B CN107847244 B CN 107847244B
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receiving chamber
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CN107847244A (zh
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E·古根海迈尔
B·弗鲁兰德
L·施耐德
Z·加维
C·西尔斯
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Covidien LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320783—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions through side-hole, e.g. sliding or rotating cutter inside catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22039—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire eccentric
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22045—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire fixed to the catheter; guiding tip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320004—Surgical cutting instruments abrasive
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320064—Surgical cutting instruments with tissue or sample retaining means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A61B2017/320775—Morcellators, impeller or propeller like means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320783—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions through side-hole, e.g. sliding or rotating cutter inside catheter
    • A61B2017/320791—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions through side-hole, e.g. sliding or rotating cutter inside catheter with cutter extending outside the cutting window

Abstract

一种导管包括组织移除元件和组织容纳腔室，所述组织容纳腔室构造成接收由组织移除元件移除的组织。该组织容纳腔室具有组织移除开口，用于从组织容纳腔室移除组织。闭合部件与组织移除开口相联，用于选择性地打开和闭合开口。

Description

包括可动远侧末端的组织移除导管
技术领域
本公开整体涉及一种包括可动远侧末端的组织移除导管，并且更加具体地涉及一种能够清除导丝组织的可动远侧末端。
背景技术
减积手术(debulking)或组织移除导管用于从身体移除不需要的组织。作为示例，斑块旋磨术导管用于从血管移除物质，以便打开血管并且改进流经血管的血流量。斑块旋磨术导管可以在导丝上前进，所述导丝延伸通过导管的导丝管腔以帮助将导丝***通过血管。目前的斑块旋磨术导管可能需要从导丝管腔移除导丝，以便清洁导管。
发明内容
在一个方面中，导管包括组织移除元件和组织容纳腔室，所述组织容纳腔室构造成接收由组织移除元件移除的组织。组织容纳腔室具有组织移除开口，用于从组织容纳腔室移除组织。闭合部件与组织移除开口相联，以选择性打开和闭合开口。组织容纳腔室和闭合部件的实施例帮助从组织容纳腔室移除组织。
其它特征将在下文某种程度上显而易见而某种程度上被指明。
附图说明
图1是导管的立体图和手柄的示意图，每个手柄均为导管的一部分；
图2是导管的放大分段截面图，所述导管包括组织容纳腔室，并且图2示出了处于部署位置中的导管的组织移除元件；
图3是导管的远端的视图，其示出了导管处于闭合位置中，并且其中组织容纳腔室和远端示出为透明，以便示出内部细节；
图4是导管的远端的视图，其示出了处于打开位置中的导管，并且其中组织容纳腔室和远端示出为透明，以便示出内部细节；
图5是导管的远端的另一张视图，其示出了处于打开位置中的导管，并且其中组织容纳腔室和远端示出为透明，以便示出内部细节；
图6是另一个实施例的导管的远端的视图，其示出了与组织容纳腔室分离的远侧末端部件和闭合部件，并且其中组织容纳腔室和远侧末端部件示出为透明，以便示出内部细节；
图6A是图6中的组织容纳腔室的放大局部图；
图6B是图6中的闭合部件的放大局部图，其中，部分被移除以示出内部细节；
图7是图6的导管的视图，其示出了处于闭合和锁定位置中的导管；
图7A是图6的导管的另一张视图，其示出了处于闭合和锁定位置中的导管；
图8是图6的导管的视图，其示出了处于闭合位置并且未锁定的导管；
图8A是图6的导管的另一张视图，其示出了处于闭合位置并且未锁定的导管；
图9是图6的导管的视图，其示出了处于打开位置中的导管；
图10是图6的导管的另一张视图，其示出了处于打开位置中的导管；
图11是图6的导管的另一张视图，其示出了止动件；
图11A是图11的导管的放大局部视图；
图12是另一个实施例的远端的视图，其示出了导管处于闭合位置中，并且其中，组织容纳腔室和远端示出为透明，以便示出内部细节；
图13是图12的导管的远端的视图，其示出了导管处于中间位置中；
图14是图12的导管的远端的视图，其示出导管处于打开位置中；和
图15是图12的导管的组织容纳腔室的远端的放大局部视图；
附图中对应的附图标记表示对应零件。
具体实施方式
公开了组织移除导管的实施例，所述组织移除导管具有可动远侧部分，用于移除存储在导管中的物质。特别地，示出的导管实施例尤其适于从血管(例如，外周动脉或者外周静脉壁)移除(例如，切除)斑块组织。另外，公开的实施例的特征还适于治疗处理血管(特别是外周动脉)的慢性完全闭塞病变(CTO)，其它身体管腔的狭窄，和其他身体管腔(例如肾脏、胆管、呼吸道、胰管、淋巴导管等)中的其它增生和肿瘤情况。通常因肿瘤包围和侵入到身体管腔中而使得肿瘤细胞生长。因此移除这种物质能够利于维持身体管腔开放。尽管其余讨论内容涉及从血管移除组织和穿透血管内的闭塞(例如，动脉中的动脉粥样硬化或者血栓闭塞物质或者静脉中的其它闭塞)的导管，但是应当理解的是本公开的教导同样可以用于其它类型的组织移除导管，包括但不局限于用于穿透各种身体管腔中的闭塞、狭窄或者增生物质和/或者从各种身体管腔中的闭塞、狭窄或者增生物质组织移除导管。
参照图1，整体用附图标记10表示根据本公开一个或者多个实施例的组织移除导管。导管10包括整体用12表示的细长导管体，所述细长导管体具有相对的近端和远端12a、12b、以及在近端和远端之间延伸的纵向轴线。在不背离本公开的范围的前提下，导管体12能够具有其它构造。整体用14表示的手柄或者控制单元布置在导管体12的近端12a上，以由用户操纵。整体用16表示的组织移除元件大体毗邻导管体12的远端12b，并且构造成从身体管腔移除(例如切割)组织并将移除的组织引导到毗邻导管体远端的组织容纳腔室17的管腔15中(图2)。导管10在导丝18上前进，所述导丝18延伸通过导管上的导丝管腔19(图3)。导丝18有助于操纵导管10通过对象的血管。
参照图2，在示出的实施例中，组织移除元件16包括可旋转切割元件，所述可旋转切割元件能够围绕旋转轴线RA1旋转以切割组织。示出的切割元件16具有：面向远侧的切割刃23，但是在其它实施例中切割刃可以面向近侧；和杯状表面20，该杯状表面用于将移除的组织向远侧引导到导管体12的组织容纳腔室17中。在其它实施例中，组织移除元件可以具有切割组织的其它构造，或者可以构造成以其它方式移除组织。例如，组织移除元件可以构造成消融组织、或者磨除组织、或者用其它方式从身体管腔移除组织。另外，组织移除元件可以相对于导管体无法旋转。
仍然参照图2，组织移除驱动轴26操作地连接到组织移除元件16的杆28(例如，牢固固定到杆)，以将旋转传递至组织移除元件。组织移除驱动轴26(例如，盘绕的驱动轴)延伸通过导管体12并且可操作地连接到手柄14中的驱动轴电马达30(图1)或其它原动机，以驱动驱动轴旋转，继而驱动组织移除元件16相对于导管体旋转。驱动轴马达30电连接到手柄14中的电源21(图1)。在示出的实施例中，驱动轴26能够在导管体12内纵向移动，以相对于导管体纵向移动组织移除元件16。组织移除元件16的纵向移动致动了组织移除元件相对于连接到导管体12远端12b的组织移除壳体34的部署和存储。壳体34的远侧部分形成了组织容器17，但是壳体和组织收集腔室可以单独形成。
组织移除元件16能够在存储位置(未示出)和部署位置(图1和图2)之间移动。在存储位置中，组织移除元件16被接收在壳体34中并且没有通过壳体的窗口或侧开口38露出。为了部署组织移除元件16，例如通过移动操作地连接至驱动轴的手柄14上的操作杆或者其它致动器40(图1)，驱动轴26相对于导管体12向近侧移动，以使组织移除元件16相对于壳体34向近侧移动。参照图2，随着组织移除元件16向近侧移动，作为凸轮的组织移除元件接合壳体34的内凸轮随动件42并且沿着所述内凸轮随动件42纵向移动，从而致使壳体相对于导管体12和组织移除元件枢转或偏转，以便部分地延伸离开窗口38。为了将组织移除元件16返回到其存储的非部署位置，驱动轴26向远侧移动(例如通过向远侧移动致动器40)，以沿着凸轮随动件42向远侧移动组织移除元件16。组织移除元件16的向远侧移动导致壳体34相对于导管体12往回枢转或偏转，使得组织移除元件被接收在壳体34中并且不能延伸到窗口38之外。当组织移除元件16处于其存储位置中时，驱动轴马达30停用(即关闭)。应当理解的是，根据本公开的原理构造的导管10可以不包括部署机构(例如，组织移除元件或者其它功能元件可以在导管体内始终部署或者可以保持在导管体内)。
由组织移除元件16切割的物质被引导通过窗口38，并且进入组织容纳腔室17的位于窗口远侧的管腔15内。导管10可以多次通过血管，其中，每次通过所获得的物质均被存储在组织容纳腔室17中。当组织容纳腔室17被充满时，从患者移除导管10并且可以清洁组织容纳腔室以备后续使用，如下文描述。
现在参照图3和图4，远侧末端部件50布置在组织容纳腔室17的远端处。远侧末端部件50可以由挠性材料形成，使得末端部件整体防损伤。组织容纳腔室17限定了组织移除开口52，以帮助从腔室移除物质。组织移除开口52通过整体由54表示的闭合部件的移动被选择性打开和闭合。闭合部件54具有：近端，所述近端接收在组织容纳腔室17的远侧开口56中；和远端，所述远端附接到远侧末端部件50的近端。远侧末端部件50的移动导致闭合部件54在组织容纳腔室17的管腔15中共同移动。特别地，远侧末端部件50和闭合部件54能够沿着组织容纳腔室17的纵向轴线A2滑动，以便在图3的闭合位置和图4的打开位置之间移动，在所述闭合位置中，组织移除开口52由闭合部件阻挡(即闭合)，在所述打开位置中，组织移除开口未被阻挡(即打开)。出于下文解释的原因，组织容纳腔室17具有布置在组织容纳腔室的远端附近的多个突片58(广泛意义上为一个或者多个凸台)。突片58延伸到组织容纳腔室17的管腔15中。在示出的实施例中，从组织容纳腔室17冲压出突片58。突片58能够具有其它构造，并且在不背离本公开的范围的前提下能够以其它方式形成。例如，突片58能够与组织容纳腔室分开地形成，并且以适当方式附接到组织容纳腔室17。
在示出的实施例中，如图4所示，闭合部件54包括细长体，所述细长体在其近端处具有勺部分60，所述勺部分60弯曲以在处于打开位置时将物质引导离开组织移除开口52。如图3所示，当闭合部件54处于闭合位置中时，细长体的塞子部分62阻挡组织容纳腔室17中的组织移除开口52。在不背离本公开的各个方面的前提下，闭合部件54可以具有其它构造。例如，闭合部件54的勺部分60能够具有圆锥状或者其它形状，并且具有多个开口以允许沿着多个方向擦拭。另外，在其它实施例中可以省略勺部分60。
闭合部件54包括多条L状狭槽64(广泛意义上一条或者多条沟槽)，每条L状狭槽64均具有周向延伸部分66、轴向延伸部分68、和将轴向延伸部分连接到周向延伸部分的结合部。在图3和图4中仅仅能够看见一条L状狭槽64，在图5中可以看见两条L状狭槽。如图4和图5所示，每条狭槽64的周向延伸部分66均布置在闭合部件54的远端附近，并且轴向延伸部分68从结合部向闭合部件的近端延伸。在一个实施例中，周向延伸部分66中的每一个均围绕闭合部件54的圆周成大约30°。在另一个实施例中，周向延伸部分66中的每一个均围绕闭合部件54的圆周成大约15°和大约45°之间的角度。组织容纳腔室17的突片58保持在相应L状狭槽64中，以便形成凸台沟槽连接部。突片58能够在狭槽64内移动，以便允许闭合部件54相对于组织容纳腔室17在打开和闭合位置之间移动。狭槽64可以具有除了L状之外的其它构造。例如，狭槽(未示出)可以为U状，以在突片在U状狭槽的其中一个支腿中轴向滑动之前允许突片沿着顺时针和逆时针方向在狭槽中周向移动。替代地，狭槽(未会出)可以是J状。
为了将闭合部件54从闭合位置(图3)移动到打开位置(图4)，远侧末端部件50可以被抓持并且沿着逆时针方向旋转(从末端50的远端观察)，因此突片在周向延伸部分66中行进并且进入周向延伸部分和纵向延伸部分68之间的结合部中。通过以这种方式旋转闭合部件54，使闭合部件的勺部分60与组织容纳腔室17中的组织移除开口52大体纵向对准。远侧末端部件50随后可以沿着轴向方向移动(例如，远侧)，以便轴向滑动(例如向远侧)闭合部件54，使得凸片58沿着狭槽64的轴向延伸部分68行进。可以通过弹簧(未示出)帮助远侧末端部件50轴向移动，所述弹簧布置在组织容纳腔室17和远侧末端部件50之间。狭槽64和突片58之间的滑动接合还防止远侧末端部件50和闭合部件54与组织容纳腔室17分离。远侧末端部件50移动，直到闭合部件54的勺部分60定位成与组织容纳腔室17中的组织移除开口52对准为止，从而打开组织移除开口。在这个位置中，突片58接合狭槽64的轴向延伸部分68的端部(例如近端)，以便阻止闭合部件54进一步轴向移动。一旦已经打开组织移除开口52，则可以以多种不同方式移除组织容纳腔室17中的物质。可以在从导管10移除物质之后以适当方式简单地抛弃该物质。替代地，还可以将物质保存在存储容器(未示出)中。应当理解的是，在不背离本公开的范围的条件下，突片58可以位于闭合部件54上并且狭槽64可以位于组织容纳腔室17中。另外，在不背离本公开的范围的前提下可以包含任何数量的突片58和狭槽64。
导丝管腔19沿着导管10延伸并且包括：近侧段19a，所述近侧段沿着组织容纳腔室17延伸(例如，安装在所述组织容纳腔室17上)；和远侧段19b，所述远侧段沿着远侧末端部件50延伸(例如，安装在所述远侧末端部件50上)。导丝管腔19的近侧和远侧段19a、19b通过间隙或空隙70间隔开。在闭合部件54处于图3的闭合位置中时，导丝管腔19的近侧段19a与远侧段19b对准。以这种方式，当闭合部件54处于闭合位置中并且导丝18完全***到导丝管腔19中时，导丝18阻止闭合部件不慎旋转，从而将闭合部件保持或者锁定在闭合位置中。导丝18可以以其它适当方式锁定闭合部件以防止组织移除开口52不慎打开。例如，导管可以包括偏压锁定元件(未示出)。
组织容纳腔室17和闭合部件54的构造允许远侧末端部件50旋转和轴向滑动，以便露出组织移除开口52，而同时又不必从导丝管腔19的任意段19a、19b中移除导丝18。当将旋转力施加到远侧末端部件50时，闭合部件54旋转，并且组织容纳腔室17上的突片58在闭合部件中的狭槽64的周向延伸部分68中行进并进入到结合部中。远侧末端部件50的旋转将弯曲应力施加到导丝18，原因在于导丝管腔19的近侧和远侧部分19a、19b不对准。导丝在施加的弯曲应力的作用下弹性弯曲并存储将闭合部件54偏压到闭合位置的回弹力。因此，当突片58位于结合部处并且移除由用户施加的旋转力时，导丝18中的回弹力能够将闭合部件54自动移动到闭合位置。然而，如果由用户保持旋转力，则随后能够由储存能量部件(例如，弹簧)向远侧拉动和/或向远侧推动远侧末端部件50，以向远侧移动闭合部件54并且使组织容纳腔室17上的突片58在闭合部件54中的狭槽64的轴向延伸部分68中行进，以打开组织移除开口52。在突片58被接收在狭槽64的轴向延伸部分68中的情况中，由导丝18产生的回弹力作用以将闭合部件54保持在打开位置中。这降低了闭合部件54滑动返回闭合位置的可能性。当从患者移除导管10时。导丝18保持在导丝管腔19中。通过将导丝18留在导丝管腔19中，相较在清洁之前必须移除导丝然后在清洁之后再将导丝***到导丝管腔中，这能够更有效地清洁导管10。
当需要闭合组织移除开口52时，向近侧推动远侧末端部件50，以使突片58进入狭槽64的轴向延伸部分68和周向延伸部分66之间的结合部中。导丝18的回弹力可以帮助闭合部件54返回到闭合位置中或者将闭合部件54自动移动到闭合位置中，从而关闭组织移除开口52。另外，如果在使用导管10之前远侧末端部件50和闭合部件54没有移动到闭合位置，则将导管***到止血阀时从远至近作用在远侧末端部件上的力能够轴向移动(例如向近侧)闭合部件，以便突片58进入结合部中，使得闭合部件在导丝18的回弹力的作用下移动到闭合位置中。
作为附加方案或者替代方案，卡扣机构(未示出)可以将远侧末端部件50和闭合部件54锁定在闭合位置或者打开位置中。可能需要小的轴向力来使卡扣机构离开原位，以相对于组织容纳腔室17移动远侧末端部件50和闭合部件54。卡扣机构可以包括金属对金属或者金属干涉配合或者金属对塑料干涉配合，以便将远侧末端部件50和闭合部件54锁定在闭合位置或者打开位置中。
参照图6至图6B，另一个实施例的导管10’包括：突出部80(广泛意义上说一个或者多个凸台)，所述突出部形成在组织容纳腔室17’的延伸构件81上位于腔室远端附近；和通道82(广泛意义地说，一条或者多条沟槽，图6B)，所述通道形成在闭合部件54’的内表面上。在示出的实施例中，闭合部件54’可滑动接收在延伸构件81中，使得闭合部件作为套管。延伸构件81限定了组织容纳腔室17’的组织移除开口52’(整体上是侧开口的形式)。组织移除开口52’可以由延伸构件81的勺部分限定。一对突出部80轴向对齐并且沿着组织容纳腔室17’的延伸构件81间隔开。通道82包括：一对周向延伸部分84，所述一对周向延伸部分轴向对齐并且沿着闭合部件54’的内表面间隔开；和轴向延伸部分86，所述轴向延伸部分在周向延伸部分84的端部之间从周向延伸部分向近侧延伸。组织容纳腔室17’上的突出部80保持在通道82中，以形成凸台沟槽连接部。突出部80在通道82中行进，以便相对于组织容纳腔室17’在打开位置和闭合位置之间引导闭合部件54’。
为了将闭合部件54’从闭合锁定位置(图7和7A)移动至打开位置(图9和图10)，远侧末端部件50’可以被抓持住并且逆时针旋转(当从远侧末端部件的远端观察时)，以使每个突出部80在通道82的相应周向延伸部分84中行进至通道的周向延伸部分和轴向延伸部分86之间的结合部，如图8所示，其中，在所述闭合锁定位置中，闭合部件覆盖组织移除开口52’。如在先前实施例中解释和图8A中示出的那样，以这种方式旋转闭合部件54’使导丝管腔19中的导丝18’弯曲，这将返回负荷作用在导丝上，以使导管10’返回到闭合位置中。
远侧末端部件50’随后能够从图8和8A中示出的旋转位置沿着轴向方向移动，以便使突出部80沿着通道82的轴向延伸部分86滑动。远侧末端部件50’被拉动，直到闭合部件54’不再覆盖组织容纳腔室17’的组织移除开口52’为止，从而打开组织移除开口，如图9和图10所示。应当理解的是，在不背离本公开的范围的前提下，突出部80可以位于闭合部件54’上，并且通道82可以形成在组织容纳腔室17’中。
参照图10、11和11A，止动件90可以布置在组织容纳腔室17’的远端附近，以便限制闭合部件54’向远侧移动离开组织容纳腔室。在示出的实施例中，止动件90包括突片，所述突片附接到组织容纳腔室17’的外表面、更加具体地附接到组织容纳腔室的延伸构件81。突片90接合形成在闭合部件54’中的狭槽92的近端，以便限制闭合部件的进一步移动。在不背离本公开的范围的前提下，止动件90可以接合导管的某些其它部分，以限制闭合部件移动。
作为附加方案或者替代方案，突片(未示出)能够被机械加工成闭合部件，并且狭槽(例如，激光切割)可以形成在组织容纳腔室中。
作为附加方案或者替代方案，多个激光切割的突片可以形成在组织容纳腔室的远端上。最近侧的突片能够将机械加工特征件锁定在闭合部件上，直到远侧末端部件抵抗垫圈(未示出)被向近侧推动、并且随后旋转和被向远侧拉动，如在先前实施例中描述的那样。由组织容纳腔室上的最远侧突片来停止远侧末端部件和闭合部件沿着远侧方向的移动。因此，锁定机构被构造到突片中，而非在旋转闭合部件时使用导丝和导丝管腔的各段之间的回弹力。
参照图12至图14，整体用10”示出了另一个实施例的导管。导管10”的组织容纳腔室17”中的组织移除开口52”(图14)允许移除存储在腔室中的物质。导管10”包括整体由54”表示的闭合部件，所述闭合部件具有：近端，所述近端接收在组织容纳腔室17”的组织移除开口52”中；和远端，所述远端附接到远侧末端部件50”的近端，使得远侧末端部件的移动导致闭合部件共同移动。远侧末端部件50”和闭合部件54”能够移动，以便选择性打开和闭合组织容纳腔室17”中的组织移除开口52”。在示出的实施例中，由轴向延伸通过组织容纳腔室17”’的远端的远侧开口限定组织移除开口52”。在不背离本公开的各个方面的前提下可以以任何其它方式产生组织移除开口52”。
组织容纳腔室17”包括在组织容纳腔室的远端附近整体用99表示的多个捕获件(仅仅示出了一个)。每个捕获件99均整体为可偏转悬臂式卡扣配合臂的形式，所述臂在其中限定了开口100。开口100围绕组织容纳腔室17”周向间隔开，并且每个开口均与组织容纳腔室的远侧边缘间隔开。多个狭缝102形成在组织容纳腔室17”的远端中，并且围绕组织容纳腔室周向间隔开以形成捕获件99。每条狭缝102均从组织容纳腔室17”的远侧边缘延伸到加宽基部104。一对狭缝102与每个捕获件99相联。如图所示，每对狭缝100均布置在捕获件100的相对的周向侧部上。每个捕获件99在由闭合部件54”接合时均能够弹性偏转或者径向向外具有挠性，如将在下文更加详细描述的那样，
闭合部件54”包括布置成毗邻闭合部件的近端的多个钩108。在示出的实施例中，钩108连接到彼此，并且作为单个钩基部单元109的一部分。当闭合部件54”的近端被完全接收在组织容纳腔室17”的远端中时，钩108被捕获在相应捕获件99的开口100中，以便将远侧末端部件50”和闭合部件54”固定到组织容纳腔室17”中。参照图15，每个钩108均包括第一斜坡表面110、第二斜坡表面112和第三斜坡表面114。第一斜坡表面110从斜坡108的前边缘以一定角度向上延伸至第二斜坡表面112。第二斜坡表面大体沿着平行于组织容纳腔室17”的外表面的平面从第一斜坡表面110延伸到第三斜坡表面114。第三斜坡表面114从第二斜坡表面112向下延伸向斜坡108的后边缘。如下文解释的那样，钩108的结构允许将闭合部件54”可释放锁定在组织容纳腔室17”中。
第一管腔116布置在组织容纳腔室17”上。第一管腔116从组织容纳腔室17”的远侧边缘延伸到组织容纳腔室的远侧边缘近侧的位置。第一管118固定布置在第一管腔116中大***于第一管腔的远端处。第二管腔120布置在闭合部件54”上。第二管腔120从闭合部件54”的近侧边缘延伸到位于闭合部件的近侧边缘远侧的位置处。第二管122固定布置在第二管腔120中并且延伸到组织容纳腔室17”的第一管腔116中并且通过第一管腔中的第一管118。第二管122包括：第一直径部分124，所述第一直径部分的尺寸设计成接收在第一管118中并且在第一管内滑动；和第二直径部分126，所述第二直径部分126比第一直径部分宽。第二直径部分126的尺寸设计成当第二中空管122相对于第一管向远侧滑动时抵接第一管118。该构造限制远侧末端部件50”和闭合部件54”移动离开组织容纳腔室17”、并且允许远侧末端部件和闭合部件相对于组织容纳腔室旋转，如将在下文进一步详细描述的那样。管118、122可以通过任何适当的手段(例如，焊接、钎焊或者粘合剂)固定布置在管腔116、120中。另外，在不背离本公开的范围前提下可以省略管腔116、120。第二管122的第一和第二直径部分124、126可以单独形成并且通过任何适当的手段(例如，焊接、钎焊或者粘合剂)附接到彼此。替代地，第一和第二直径部分124、126能够整体形成。第一和第二管118、122分别与近侧和远侧导丝管腔部分19a、19b对准，以便部分限定导丝管腔19”。导丝(未示出)能够***通过导丝管腔19”，其分别包括第一和第二管118、122。
在闭合位置中，闭合部件54”被接收在组织容纳腔室17”的组织移除开口52”中，并且闭合部件上的钩108被捕获在捕获件99的开口100中，以便将远侧末端部件50”和闭合部件固定到组织容纳腔室。为了打开组织移除开口52”，将沿着远侧方向的轴向拉动力施加到远侧末端部件50”。足够大小的力导致闭合部件54”向远侧移动，并且捕获件99的内表面沿着钩108的第一斜坡表面110向上。随着捕获件99沿着第一钩表面110向上，捕获件弹性向外偏转并且离开钩108，从而提供了用于闭合部件54”的间隙，以继续闭合部件向远侧的移动。闭合部件54”的继续向远侧移动将导致捕获件99的内表面抵达第二斜坡表面112然后沿着第三斜坡表面114向下，从而使钩脱离开口100。一旦钩108脱离开口100，则闭合部件54”和钩108能够被完全拉出组织容纳腔室17”。当第二中空管122的第二直径部分126接合第一中空管118时，远侧末端部件50”和闭合部件54”停止向远侧移动。
在从组织容纳腔室17”移除闭合部件54”之后，远侧末端部件50”和闭合部件54”旋转，由此第二管122围绕第一管118的轴线旋转，直到打开组织移除开口为止。例如，远侧末端部件50”和闭合部件54”能够围绕第一管118旋转大约180度以打开组织移除开口52”。还可以设想其它旋转角度。因此，远侧末端部件50”和闭合部件54”围绕与组织容纳腔室17”的纵向轴线径向偏离的轴线旋转。在示出的实施例中，围绕与导丝管腔19”的至少一部分重合的轴线旋转。结果，导丝(未示出)和导丝管腔19”没有因远侧末端部件50”和闭合部件54”的旋转处于剪切状态或者受到变形。
为了闭合组织移除开口52”，远侧末端部件50”和闭合部件54”旋转回成与组织移除开口对准并且向近侧推动，直到闭合部件上的钩108由捕获件99的开口100捕获为止，从而将远侧末端部件50”和闭合部件锁定到组织容纳腔室17”。随着将闭合部件54”向近侧推入组织容纳腔室17”中，钩108的第三斜坡表面114接合捕获件99的内表面。足够大小的力导致闭合部件54”向近侧移动并且捕获件99的内表面沿着斜坡108的第三斜坡表面114向上。随着捕获件99沿着第三斜坡表面114向上，捕获件弹性向外偏转并且离开钩108，从而提供了用于闭合部件54”的间隙，以继续闭合部件向远侧的移动。闭合部件54”的继续向远侧移动将导致捕获件99的内表面抵达第二斜坡表面112然后沿着第一斜坡表面110向下，从而将钩108捕获在开口100中。
还能够在不使用单独冲洗工具的情况下清洁本实施例的导管10”。通过调节导管10”的填充行程长度，能够通过在组织容纳腔室中向远侧推动组织将组织容纳腔室17”中的任何组织推出导管10”。在这个实施例中，切割器驱动器(未示出)可以以至少两种设置操作，以控制切割器的填充行程。例如，在组织移除开口52”闭合时切割器驱动器可以以第一设置操作以填充组织，在组织移除开口打开时切割器驱动器可以以第二设置操作以从导管10”排出组织。因为组织移除开口52”与组织容纳腔室17”的纵向轴线对准，所以能够仅仅通过这个操作从导管10”移除组织。为了进一步帮助以这种方式从导管10”移除组织，组织容纳腔室17”的远端可以具有成锥形内直径，以便减小填充的组织和组织容纳腔室之间的摩擦。
通过详细描述本发明的实施例，应当理解的是在不背离本发明的由附属权利要求限定的范围的前提下修改方案和变形方案是可行的。
当介绍本发明的元件或者其优选元件(多个优选元件)时，冠词“一个”、“一种”、“该”和“所述”旨在表示存在元件中的一个或多个。术语“包含”、“包括”和“具有”旨在包括并且表示除了列举的元件之外还具有其它元件。
因为在不背离本发明的范围的前提下可以在上述构造、产品和方法中实施多种变化，所以表示包含在上述描述中并且在附图中示出的所有事件均理解为解释性而非限制。

Claims (16)

1.一种用于从身体管腔移除组织的组织移除导管，所述组织移除导管包括：
细长体，所述细长体具有近端和远端；
毗邻所述细长体的远端的组织移除元件，所述组织移除元件构造成接合所述身体管腔并且从所述身体管腔移除组织；
毗邻所述细长体的远端的组织容纳腔室，所述组织容纳腔室构造成接收由所述组织移除元件移除的组织，所述组织容纳腔室限定了腔室管腔并且具有：连接到所述细长体的远端部分的近端、与所述组织容纳腔室的近端相对的远端、在所述组织容纳腔室的近端和远端之间延伸的纵向轴线、和毗邻所述组织容纳腔室的远端并且与所述组织容纳腔室的远端间隔开的组织移除开口；
位于所述组织容纳腔室的腔室管腔中的闭合部件，所述闭合部件能够在所述腔室管腔内沿远侧方向从闭合位置纵向滑动到打开位置，在所述闭合位置中，所述闭合部件阻止所述组织容纳腔室中被移除的组织通过所述组织移除开口离开，在所述打开位置中，所述闭合部件允许所述组织容纳腔室中被移除的组织通过所述组织移除开口离开。
2.根据权利要求1所述的组织移除导管，所述组织移除导管还包括将所述闭合部件连接到所述组织容纳腔室的凸台沟槽连接部。
3.根据权利要求2所述的组织移除导管，其中，所述凸台沟槽连接部包括：沟槽，所述沟槽与所述闭合部件相关联并且沿着所述闭合部件延伸；和凸台，所述凸台位于所述组织容纳腔室上并且保持在所述沟槽中并且能够沿着所述沟槽移动。
4.根据权利要求3所述的组织移除导管，其中，所述沟槽为大体L状，并且具有沿着所述闭合部件延伸的长臂和横向于所述闭合部件延伸的短臂。
5.根据权利要求4所述的组织移除导管，其中，在所述凸台处于所述L状沟槽的短臂中时，所述闭合部件处于锁定构造并且被防止在所述腔室管腔内纵向滑动，并且其中，在所述凸台处于所述L状沟槽的长臂中时，所述闭合部件处于未锁定构造中并且被允许在所述腔室管腔内纵向滑动。
6.根据权利要求5所述的组织移除导管，其中，所述组织容纳腔室的远端限定了远侧开口，其中，所述闭合部件延伸通过所述组织容纳腔室的远侧开口并且进入到所述腔室管腔中。
7.根据权利要求6所述的组织移除导管，所述组织移除导管还包括末端部件，所述末端部件限定了所述组织移除导管的远端，其中，所述末端部件连接到所述闭合部件的远端。
8.根据权利要求7所述的组织移除导管，其中，所述末端部件能够相对于所述组织容纳腔室旋转，以使所述闭合部件在其锁定构造和未锁定构造之间移动。
9.根据权利要求8所述的组织移除导管，所述组织移除导管还包括位于所述组织容纳腔室上的第一导丝管腔和位于所述末端部件上的第二导丝管腔，其中，当所述闭合部件处于其锁定构造中时，所述第一导丝管腔和第二导丝管腔对准以接收导丝通过其中。
10.根据权利要求9所述的组织移除导管，其中，在所述闭合部件处于其未锁定构造中时，所述第一导丝管腔和第二导丝管腔不对准。
11.根据权利要求10所述的组织移除导管，其中，所述末端部件能够相对于所述组织容纳腔室旋转，以在导丝被接收在所述第一导丝管腔和第二导丝管腔中时将所述闭合部件从其锁定构造移动到其未锁定构造。
12.根据权利要求1所述的组织移除导管，其中，所述闭合部件能够选择性地锁定在所述闭合位置中，以防止所述闭合部件不慎移动到所述打开位置，并且其中，所述闭合部件能够选择性地在所述闭合位置中解锁，以允许所述闭合部件移动到所述打开位置。
13.根据权利要求12所述的组织移除导管，其中，所述组织容纳腔室的远端限定了远侧开口，其中，所述闭合部件延伸通过所述组织容纳腔室的远侧开口并且进入到所述腔室管腔中。
14.根据权利要求13所述的组织移除导管，所述组织移除导管还包括末端部件，所述末端部件限定了所述组织移除导管的远端，其中，所述末端部件连接到所述闭合部件的远端。
15.根据权利要求14所述的组织移除导管，其中，所述末端部件能够相对于所述组织容纳腔室旋转，以便选择性锁定和解锁所述闭合部件。
16.根据权利要求14所述的组织移除导管，所述组织移除导管还包括位于所述组织容纳腔室上的第一导丝管腔和位于所述末端部件上的第二导丝管腔，其中，所述末端部件能够相对于所述组织容纳腔室旋转，以便当导丝被接收在所述第一导丝管腔和第二导丝管腔中时选择性锁定和解锁所述闭合部件。
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