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CN1688240A - 活塞致动的内窥工具 - Google Patents

活塞致动的内窥工具 Download PDF

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CN1688240A
CN1688240A CN03823361.4A CN03823361A CN1688240A CN 1688240 A CN1688240 A CN 1688240A CN 03823361 A CN03823361 A CN 03823361A CN 1688240 A CN1688240 A CN 1688240A
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达恩·奥兹
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Abstract

本发明提供一种内窥装置，其具有插进患者体内的远侧端(102)和留在患者体外的近侧端。该内窥装置包括置于该内窥装置近侧端的附近区域的近侧缸(404)。近侧活塞(406)可滑动地容置在该近侧缸内。远侧缸(328)置于该内窥装置远侧端的附近区域，且远侧活塞(310)可滑动地容置在该远侧缸内。用于容纳液体的管(402)连接在该近侧缸和远侧缸之间。工具(例如活组织检查工具115)被连接，以由该远侧活塞的位移进行致动，从而响应于该远侧活塞的位移对身体组织或身体的内容物施加机械作用。

Description

活塞致动的内窥工具
发明领域
本发明大体上涉及对柔性医疗装置用的工具的致动，具体地涉及在医疗过程中用于致动内窥工具的方法和装置。
发明背景
使用内窥镜检查体腔在本领域是公知的。用柔性内窥镜直接检查胃肠道会产生诊断和治疗上的优点，这使得该方法成为标准的现代医疗过程。最常用的内窥过程之一是结肠镜检查，其具有广泛的用途，包括癌症诊断、胃肠出血源的确定、观察因肠发炎所影响的部位、除去息肉及减少肠扭结和肠套叠。
柔性内窥镜通常包括工作通道，其穿过内窥镜的全长。这些通道的用途之一是使工具穿过内窥镜以在身体内进行诊断和治疗过程。这种工具包括例如微型活检钳，其可穿过上述通道并从内窥镜的远侧端伸出，以从检查区域取出活组织检查样品。通常，在该工具自身后面利用线缆或绳索来控制这种工具，该线缆或绳索穿过外壳延伸至内窥镜远侧端。医生通过在近侧端对线缆或绳索施加拉力，从而使该工具在远侧端产生所需要的动作。
利用这种技术致动工具的程度，受到每个线缆和包围该线缆的外壳间的摩擦力的限制。特别地，如果医生仅需要克服在胃肠道中转弯一次，那么必须在近侧端施加力F1以在远侧端产生力F2，且近似地F1＝F2*eμα，其中μ是线缆和外壳间的摩擦系数，α是由胃肠道中转弯所限定的有效角。如果内窥镜在胃肠道中穿过i个转弯αi(通常情况下都是这样)，那么合力可能会显著地(并经常是应该被禁止地)增大到 F 1 = F 2 * e μΣ | α i | .
为克服使用基于外壳中线缆的系统所引起的摩擦作用，已尝试向内窥镜引入液压装置，但没有在商业上得到成功。本发明人所知的所有这些液压系统都很复杂、昂贵、体积庞大，和/或需要外部能源或压力源，以及控制这些能源或压力源的设备。由于这些缺点，仅仅基于线缆的技术目前使用在内窥转向和工具-控制的应用当中。
在此引入作为参考的Dill等人的美国专利5,569,299公开了一种内窥泌尿道活检钳，其带有一个固定钳和一个活动钳，其中该活动钳由线缆致动，且该线缆在支承这两个钳的中空管内延伸。由卫生保健专业人士在近侧端致动该线缆来操作该活检钳。
在此引入作为参考的Smith等人的美国专利5,431,645公开了利用内窥镜近侧端附近的各种能源来远程致动内窥工具的技术，所述各种能源包括电源、机械源、液压源和气动源。
在此引入作为参考的Koblish等人的美国专利5,779,646公开了一种可偏转的活组织检查导管，其中从该导管近侧端延伸至远侧端的控制线缆用于使远侧梢部偏转和/或致动活检钳。所述控制线缆与活塞相连，该活塞位于导管近侧端处的手柄中的缸内，从而移动该活塞可使得操作人员控制远侧梢部的偏转和/或致动活检钳。
在此引入作为参考的Pasricha等人的美国专利5,674,205公开了一种用于将药物输送至体腔内某部位的装置。该装置类似于细长注射器，其带有含一剂药的远侧活塞/喷针装置，其中使用该注射器的医生操纵端经连接远侧端和近侧端的流体填充管来致动该远侧装置。
在此引入作为参考的Yamamoto等人的美国专利6,059,719公开了一种内窥镜系统，其包括多个内窥镜模块，其中不同的治疗器械安装在内窥镜模块内，且各个治疗模块可自由地更换。在某些实施方案中，利用横跨内窥镜长度的传动线缆来提供致动治疗模块所必需的力。其他实施方案包括液体填充通道，其将远侧活塞/缸结构连接到输送流体压力的近侧装置上，从而使该远侧活塞移动。传动线缆使该远侧活塞与治疗模块连接，从而该远侧活塞的移动可致动该治疗模块。
在此引入作为参考的Peirs等人的论文(标题为“A MicroRobotic Arm For A Self Propelling Colonoscope”，出版于1998年6月的New Actuators上，Proc.Actuator 98，6th Int.Conf.576-579页)公开了一种用于结肠镜检查并包括柔性臂的自推进式内窥系统，其中该柔性臂可由与内窥工具连接的形状记忆合金材料进行控制。或者通过对形状记忆合金机构的加热/冷却，或者经远侧活塞/缸装置利用液压装置，来控制内窥工具。简单的活塞/缸装置可与缸上的单个压力端口一起使用，从而必须同时使用正压力和负压力来操纵所连接的工具。
发明概述
本发明某些方面的一个目的是提供一种改进的系统和方法，用于在内腔中致动工具。
本发明某些方面的另一目的是提供一种改进的机构，以在患者体腔内致动工具，用于检查、诊断或治疗的目的。
本发明某些方面的另一目的是提供一种改进的机构，以在患者体腔内致动工具，用于进行活组织检查或进行其他过程。
在本发明优选实施方案中，用于对患者胃肠道或其他体腔中的组织或内容物施加机械作用的内窥工具，穿过置于该体腔中的柔性内窥镜中的通道而送进。内窥工具被送入目标(例如组织、肠结石或结石)的附处，且在连接到该工具上的致动机构的协助下在通道远侧端附近进行致动，从而对目标施加机械作用。该致动机构包括一个或多个缸，每个缸包括一个活塞，从而该活塞的移动可致动与该工具相连接的连杆，以使该工具发挥作用。活塞的移动可通过将液体引入相应的缸或从相应的缸中排出液体来实现。通过一个或多个柔性管的密闭系统(其经过工作通道)，使液体从内窥镜的近侧端输送到内窥镜远侧端附近的致动机构缸。本发明的这些实施方案可避免使用致动工具用的、穿过内窥镜长度的线缆，从而使通常与基于线缆进行致动相关的困难(如摩擦)最小化。
优选地，通过在压力下将流体驱动到活塞中(而不是如本领域中公知的被液压致动的工具那样从活塞中排出流体)，来加压致动机构中的活塞，从而致动该工具。在本专利申请的说明书和权利要求中，“致动”工具是指通过该工具所施加的所需力进行操作，如闭合活检钳。在基于从液压机构中排出液体的致动机构中，仅可能施加一个大气压的负压力，从而由该工具所施加的力受到限制。当在正压力下将液体驱动到活塞内时，可以施加更大的力。
用于经柔性管向致动机构中的缸供应液体的装置，优选位于内窥镜的近侧端并在患者体外。在本发明优选实施方案中，驱动活塞/缸系统被用于向柔性管中的液体提供压力，从而驱动该致动机构。优选地，操作人员使用手和/或脚的移动使一个或多个驱动活塞在其各自缸中位移，从而使液体进入该致动机构缸中或从其中排出，且在内窥镜远侧端附近产生相应的活塞移动及工具所需的致动。从而，操作人员所施加的物理力直接地或成比例地施加以致动内窥工具，使操作人员具有反馈的感觉。在相对较短的训练和实践时间后，操作人员通常可以知晓施加到机械用户-界面装置(如操纵杆)上的力大小，以在特定过程中操纵该工具。杠杆作用，或该致动机构的机械和/或液压设计的其他方面，可用于控制致动该工具所需要的物理力。
在本发明优选实施方案中，每个致动机构缸包括用于使液体引入或排出从而使相应活塞移动的一个端口。活塞将每个致动机构缸分成两个区域：(a)液体传输区域，其包括一个端口，其中通过该端口可主动地加入或排出液体；及(b)被动区域，其可在一端敞开，或其可包括弹簧或固定量的可压缩流体(如空气)。优选地，该致动机构缸与内窥镜的纵轴对齐，且该液体传输区域比该被动区域更接近内窥镜的远侧端。对某些应用而言，这种结构是优选的，这是当液体被加到致动机构缸之一的远侧端时，在使活塞与工具相连接的致动机构的元件中产生张力，从而降低由于挤压载荷而使薄元件屈曲的可能性。在两个或多个致动机构缸间的机械连杆，优选被设计成在液体加到一个或多个缸的液体传输区域中时，用于保持这些致动机构元件中的拉伸负载。可选择地或另外地，一个或多个适当构造的杆与致动机构缸相连接，以使得在施加在缸液体传输区域中施加或排出液体时处于挤压状态，从而便于工具的致动。
对于每个致动机构缸的被动区域含有可压缩流体(例如空气)的应用场合而言，流体通常基本上用作弹簧，并用于使活塞返回其平衡位置。可选择地或另外地，该区域包括刚性弹簧，用于一旦没有外压施加到缸上时使活塞返回其平衡位置。
在本发明另一个优选的实施方案中，每个致动机构缸包括位于活塞每一侧上的两个端口，其分别与缸的两个液体传输区域相连，其中液体被主动地加入液体传输区域中或从其中排出。柔性管将液压压力从内窥镜的近侧端传递至每个端口。响应于活塞相反侧上的压力差，给定活塞启动了在致动机构中的移动。通过调节活塞每一侧上的压力，可精确控制由活塞传送至致动机构连杆上的力。优选地，在该工具致动的各个期间，活塞两侧上的压力都是正压力。
因此，根据本发明实施方案提供了一种内窥装置，具有插进患者体内的远侧端和保留在患者体外的近侧端，该内窥装置包括：
近侧缸，其位于内窥装置近侧端的附近区域；
近侧活塞，其可滑动地容置在该近侧缸内；
远侧缸，其位于内窥装置远侧端的附近区域；
远侧活塞，其可滑动地容置在该远侧缸内；
用于容纳液体的管，其连接在近侧缸和远侧缸之间；及
工具，其被连接以由该远侧活塞的位移所致动，从而响应于该远侧活塞的位移对身体的组织或身体的内容物施加机械作用。
在一个实施方案中，该工具、该远侧缸、该远侧活塞和该管适合于穿过内窥镜的工作通道，从而使用该内窥镜来接近身体内的区域。
在一个实施方案中，该工具适合于接近患者胃肠道的一部分。
对于一些应用场合，该工具包括活组织检查工具。可选择地或另外地，该工具包括治疗工具。
在一个实施方案中：
(a)该远侧缸包括位于该远侧缸的各个侧面上的两个区域，
(b)该管适合于与所述区域中的第一区域相连通，
(c)所述区域中的第二区域被构造成使得，该远侧活塞在第一方向上的移动可改变第二区域中的流体压力，及
(d)该远侧活塞与该远侧缸连接，从而响应于流体压力的变化在与第一方向相反的第二方向上经受力。
对某些应用而言，该近侧活塞适合于手动操作。在一个实施方案中，该内窥装置包括与该近侧活塞连接的连杆，其适合于便利该近侧活塞的手动操作。
对某些应用而言，该工具与该远侧活塞连接，从而由于该近侧活塞的操作通过液体对该管加压来致动该工具。例如，该工具包括钳子，及其中通过对该管加压来致动该工具以使该钳子关闭。该工具包括勒除器，及其中通过对该管加压来致动该工具以使该勒除器关闭。
根据本发明一个实施方案还提供一种内窥装置，具有插进患者体内的远侧端和保留在患者体外的近侧端，该内窥装置包括：
远侧活塞；
远侧缸，其中在该远侧缸内可滑动地容置有该远侧活塞，该远侧缸位于该内窥装置远侧端的附近区域，且该远侧缸具有邻近该远侧活塞的第一远侧端口和远离该远侧活塞的第二远侧端口；
工具，其被连接以由该远侧活塞的位移进行致动；
近侧活塞；
近侧缸，其中在该近侧缸内可滑动地容置有该近侧活塞，该近侧缸位于该内窥装置近侧端的附近区域，该近侧缸具有邻近该近侧活塞的第一近侧端口和远离该近侧活塞的第二近侧端口；及
第一管和第二管，其中该第一管将其中的一个近侧端口与其中的一个远侧端口相连接，且该第二管将其中的另一个近侧端口与其中的另一个远侧端口相连接，以使得：
(a)该近侧活塞的近侧移动可驱动液体通过其中的一个管而将正压力施加至该远侧活塞的第一侧，以使该远侧活塞在第一方向上位移，并对该工具进行致动以处于第一状态，及
(b)该近侧活塞的远侧移动可驱动液体通过其中的另一个管而将正压力施加至该远侧活塞的第二侧，以使该远侧活塞在第二方向上位移，并对该工具进行致动以处于第二状态。
在一个实施方案中，该工具、该远侧缸、该远侧活塞和该管适合于穿过内窥镜的工作通道，从而使用该内窥镜来接近身体内的区域。
在一个实施方案中，该工具适合于接近患者胃肠道的一部分。
对某些应用而言，该工具包括活组织检查工具和/或治疗工具。
在一个实施方案中，该近侧活塞适合于手动操作。例如，该装置包括与该近侧活塞连接的连杆，其适合于便利该近侧活塞的手动操作。
根据本发明一个实施方案还提供了一种内窥装置，具有插进患者体内的远侧端和保留在患者体外的近侧端，该内窥装置包括：
第一近侧缸和第二近侧缸，其置于该内窥装置近侧端的附近区域；
第一近侧活塞和第二近侧活塞，其可滑动地容置在各自的近侧缸内；
至少一个远侧缸，其置于该内窥装置远侧端的附近区域；
至少一个远侧活塞，其可滑动地容置在所述至少一个远侧缸内；
用于容纳液体的第一管，其连接在该第一近侧缸和所述至少一个远侧缸之间；
用于容纳液体的第二管，其连接在该第二近侧缸和所述至少一个远侧缸之间；
机械连杆，其连接到所述第一近侧活塞和第二近侧活塞上，以使得：(a)当该机械连杆在第一方向上位移时，移动该第一近侧活塞并在该第一管中产生正压力，及(b)当该机械连杆在第二方向上位移时，移动该第二近侧活塞并在该第二管中产生正压力；及
工具，其被连接以由所述至少一个远侧活塞的位移进行致动，从而响应于该远侧活塞的位移对身体组织或身体的内容物施加机械作用。
结合附图从下面对本发明优选实施方案的详细说明中可以更充分地理解本发明，其中：
附图简要说明
图1是根据本发明优选实施方案的内窥工具的示意剖面图，其包括液压致动机构；
图2是根据本发明另一优选实施方案的内窥工具的示意剖面图，其包括液压致动机构；
图3是根据本发明另一优选实施方案的内窥工具的示意剖面图，其包括液压致动机构；
图4是根据本发明另一优选实施方案的内窥工具的示意剖面图，其包括液压致动机构；
图5是根据本发明另一优选实施方案的内窥工具的示意剖面图，其包括液压致动机构；及
图6是根据本发明另一优选实施方案的内窥工具的示意剖面图，其包括液压致动机构。
优选实施方案详细说明
根据本发明优选实施方案，现参考图1，该图1是包括被液压致动的工具的柔性内窥装置100的示意剖面图。内窥装置100包括远侧部分102，其穿过置于患者胃肠道中的内窥镜80的工作通道82而送进。内窥装置100还包括近侧部分104，其中该近侧部分的一部分保留在患者外侧，且该工具的操作人员够得着这一部分。通常，该工具包括活组织检查工具115，其包括两个相对的活检钳114。活组织检查工具115被置于内窥装100的远侧梢部附近，用于在胃肠道内对组织切除或取样。
用于致动活组织检查工具115的装置，被置于远侧部分102附近的远侧梢部。在优选实施方案中，每个活检钳114都包括勺状杆，且可绕共有枢轴点113旋转，使得每个杆的勺部分能抓住并切取组织。枢轴点113与端盖112相连，该端盖与内窥装置100的远侧梢部相连。楔形元件110的移动可致动钳114，从而楔形元件110的远侧移动，即在远侧方向上的移动(如图所示向上方向)，可使活检钳关闭；而楔形元件110的近侧移动，即在近侧方向上(向下)的移动，可使得活检钳张开。在优选实施方案中，活组织检查工具115包括弹簧130；当楔形元件110朝近侧方向移动时，该弹簧可用于使活检钳114张开。
机械止动件118优选地连接于远侧部分102的内部，且位于活塞108的远侧，从而当施加正压力时限制活塞的移动。通常，当内窥装置100穿过工作通道82送进时，压力作用在活塞108上，从而靠着机械止动件118挤压活塞108，且使得钳114保持于关闭位置。
楔形元件110通过杆120连接于远侧活塞108，从而活塞108的移动可使楔形元件110进行相等的移动。优选地，杆120的长径比相对较小(例如小于10)，以使得杆120能在无屈曲或明显弯曲的情况下传递挤压载荷。可选择地，可以不设置杆120，使得活塞108直接固定到楔形元件110上。
通过移动近侧活塞106实现对活组织检查工具115的致动，且所述近侧活塞106的移动改变了内装液体并处于活塞106和活塞108之间的管道116的压力，从而控制作用于活塞108的力。优选地，管道116内装有基本上不可压缩的、生物相容性液体(例如水或盐溶液)。使用活塞106来加压管道116，从而在远侧方向上驱动活塞108，由此关闭钳114。通过与活塞106连接且在近侧部分104远侧端附近够得着的机械连杆122，操作人员可启动活塞106的移动。在优选实施方案中，连杆122是简单的杆，其移动直接施加于活塞106。可选择地，连杆122包括操纵杆、轮子或其他机构，以提高该工具的易用性，例如降低操作人员所需施加的力。需要说明的是，使用近侧活塞106，可避免了在本领域公知的、液压内窥活组织检查工具所需的更复杂近侧压力装置。
图2是根据本发明优选实施方案的柔性内窥装置200的示意剖面图，其包括被液压致动的工具。柔性内窥装置200大体与参考图1所述的内窥装置100的作用方式相近，但包括不同的机构来将活塞108的移动转化成对活组织检查工具117的致动。
由于管道116中的压力所引起的活塞108移动被传递至杆120、连杆元件124和活检钳114的近侧端。以这种方式，活塞108的远侧移动倾向于张开钳114且拉紧弹簧130，而活塞108的近侧移动倾向于在弹簧130协助下关闭钳114。因此，关闭活组织检查工具117的钳114，将使杆120和连杆元件124拉紧，从而使得这些部件的屈曲的可能性最小。另外，通过调整活组织检查工具117的连杆中的元件大小，可调节由活检钳114所施加的力，使其成为施加于活塞106上的力的所需倍数。
需要说明的是，使用近侧活塞106，可避免本领域公知的、液压内窥活组织检查工具所需的更复杂近侧压力装置。
图3是根据本发明优选实施方案的柔性内窥装置400的示意剖面图，其包括被液压致动的工具412。用于可便利该工具操作的装置置于远侧部分102中，且优选地包括多个缸328，每一个缸都内置有活塞310。有利地是，多个缸328使得医生能独立地控制任何一个钳114，例如可偏离内窥装置400的中心线来操作被液压致动的工具412。可以理解的是，在其他应用场合中所用的其他内窥工具或成套工具(图未示)也可以由多个缸328所带来的操作自由度提高中获益。
每个活塞310优选地连接于各自线缆302的一端。线缆302的相反端连接于活检钳114的相应部分。在优选实施方案中，连接于远侧部分102的横档304包括多个滑轮306，以在活塞310和钳114之间确定线缆302的线路。
通过经由柔性管402将液体输送至缸328或从中排回液体，来驱动活塞310的移动。优选地，每个缸328都与内窥镜的纵轴平行排列，且液体在缸远侧端附近被输送至端口414或从其中排回。每个缸被活塞310分成两部分：(a)更接近于远侧部分102远侧端的液体传输部分308，在其中液体被输送或排回，及(b)更接近于远侧部分102近侧端的被动部分312。
弹簧326优选地连接于活检钳114上，以倾向于张开该钳。从而，使得施加于缸328上以使活塞310向远侧移动和张开钳114的抽吸力最小，或者不需要。抽吸力的减小，可减少与柔性管402收缩相关的潜在问题。再者，作为使内窥镜产生有用移动的一种方法，抽吸通常被限制于一个大气压，而正压力可能会超过一个大气压。使用本发明原理所进行的实验，仅仅使用手所容易产生的力就可在远侧端产生50个大气压的正压力，来施加于根据本发明实施方案而优选的简易低廉装置中。需强调的是，用于液压内窥活组织检查工具的现有技术系统，通常需要复杂而昂贵的装置，其使用泵和压力调节装置或其他动力设备进行操作。
对某些应用而言，每个缸328的被动部分312包括孔408；当活塞310发生位移时，该孔可允许流体(通常为空气)进入或离开。在本发明优选实施方案中，缸328的被动部分包括可选择地用来替换弹簧326的弹性元件(如弹簧)，其用于使活塞310保持于其平衡位置。可选择地，缸328的被动部分被密封，且封装有可压缩流体(如空气)；当活塞310发生位移时，该可压缩流体的作用相当于弹簧，使得活塞返回到其平衡位置。
响应于在驱动缸404中的相应驱动活塞406的操作，液体被输送至每个缸328或从中排回。每个驱动活塞406优选地通过其中的一个柔性管402连接于各自的缸328。对驱动活塞406施加远侧定向力，可对驱动缸404中的液体加压。该压力通过在柔性管402和缸328中的液体进行传递，且作用于活塞310，以对被液压致动的工具412如前所述地进行致动。特别地，活塞406的远侧移动可使钳114关闭，而弹簧326的伸展可使钳114张开。施加于驱动活塞406的驱动力与活塞310受到的压力之比，通常与两个活塞表面的面积之比成比例。从而，可通过相对于活塞310的面积减少活塞406的面积，来精确地控制被液压致动的工具412。用这种方式，操作人员产生的活塞406移动，可通过杠杆作用使活塞310产生精确的移动。可通过适当地给定驱动活塞406和活塞310的尺寸，来选择致动该工具所需的力。
在本发明的一些优选实施方案中，机械连接于活塞406上的机械连杆410(如操纵杆)，被用于致动该驱动活塞406，以使对该工具的致动更符合人机工程学。对于更多缸被用于内窥镜的远侧端和/或近侧端的一些应用而言，可对该连杆进行适当的改变，从而使操作人员更方便地使用。
图4是根据本发明优选实施方案的柔性内窥装置460的示意剖面图，其包括被液压致动的工具450。如参考图1所述的那样，楔形元件110的移动可致动活检钳114，从而楔形元件110的远侧移动可使活检钳关闭，而近侧移动可使活检钳张开。与一些已知的液压活组织检查工具控制装置相比，被液压致动的工具450优选地不包括用于张开或关闭活检钳114的弹簧。
操作人员通过控制驱动活塞406的移动，来启动对被液压致动的工具450的致动。驱动活塞406的移动会改变远侧柔性管316和近侧柔性管314中的压力，其中所述管分别：(a)将驱动缸404的远侧驱动部分322连接到缸328的远侧部分309上，以及(b)将驱动缸404的近侧驱动部分324连接到缸328的近侧部分313上。用这种方法，通常可精确控制作用于活塞310上的力。优选地，柔性管314和316内充满基本上不可压缩的生物相容性液体(例如水或盐溶液)。
操作人员经由机械连杆122启动活塞406的移动，其中该连杆122连接于活塞406且在近侧部分104的近侧端附近可以够得着。有利的是，通过施加正压力于柔性管316和314内，可分别使活塞310在近侧方向和在远侧方向上移动。特别地，驱动活塞406的近侧移动可关闭钳114，而驱动活塞406的远侧移动可张开钳114。从而，通常在不使用弹簧情况下，图4中所示的本发明实施方案响应于正压力的施加而可在两个方向上进行有效工作。有利的是，可轻易地产生较高的正液压压力，来张开和关闭活检钳，或适当地致动其他内窥工具。
图5是根据本发明优选实施方案的柔性内窥装置400的示意剖面图，其包括被液压致动的工具412。图5所示的实施方案大体与图3所示相似，但是在图5中机械连杆410(在图3所示包括两个操纵杆)被替换为单个操纵杆500。当使用者朝一个方向移动操纵杆500时，其中一个驱动缸404中的压力增大，相应地增加了与其连接的柔性管402中的压力。当操纵杆500朝另一个方向移动时，另一个驱动缸404中的压力增大，相应地增加了与该驱动缸连接的柔性管402中的压力。
图6是根据本发明优选实施方案的柔性内窥装置600的示意剖面图，其包括液压致动勒除器602。如参考图4所示那样，内窥装置600大体与内窥装置460相似，但是图4中所示的活检钳114和相关装置在图6所示的实施方案中被勒除器602替换。勒除器602通常用于套住患者组织的息肉或其他部分。当勒除器逐渐撤回到壳体604(其安装在内窥装置600的远侧端片612上)中时，该组织被除去。
通过移动驱动活塞406，可启动对勒除器602的致动。如前所述，驱动活塞406的移动，可改变远侧柔性管316和近侧柔性管314中的压力。用这种方法，通常可精确控制作用于活塞310上的力。接下来，活塞310的移动优选地直接转换为对勒除器602的致动(即张开或关闭)。从而，通常地通过分别对柔性管314和316施加正压力来实现勒除器602的张开和关闭。
可以理解地是，勒除器602可以替换成可缩回的钳子或其他本领域所知的医疗工具。
在本发明优选实施方案中，本文所述的技术可与共同未决的美国临时专利申请中公开的方法和装置相结合使用；其中，该申请的暂定序列号为60/395,694，题目为″Piston-actuated endoscopicsteering system″，申请日为2002年7月11日，且被转让给本专利申请的受让人，在此引入作为参考。该专利申请陈述：
″在本发明优选实施方案中，在内窥镜远侧端附近的转向机构的协助下，柔性内窥镜的远侧部分通过胃肠道送进。该转向机构包括一个或多个缸，每个缸包括一个活塞，其中一个或多个活塞的移动可致动转向机构中的杆、线缆和/或绳索，从而使内窥镜的远侧端转弯。可通过将流体引入相应的缸或从相应的缸中排出，来实现一个或多个活塞的移动，从而实现活塞的移动。经柔性管的密闭系统，可使流体从内窥镜的近侧端输送至内窥镜远侧端附近的转向机构缸中。″
可选择地或另外地，本文所述的技术与PCT专利公开文献WO 00/44275中所公开的方法和装置结合使用，其题目为″Propulsion of a probe in the colon using a flexible sleeve″，且其在美国国家阶段的专利申请号为09/646,941，其被转让给本专利申请的受让人，在此引入作为参考。第’275号专利公开文献中陈述：
″在本发明优选实施方案中，含有内窥器械的探针，利用连接于该探针上的柔性套的膨胀穿过患者的靠下胃肠道而送进。该柔性套的一端通常被锚定在患者的肛门处或紧邻患者的肛门。随着该柔性套被充气(优选使用加压气体)，该探针被向前推进，且该柔性套在该探针和肛门间逐渐送出(feed out)。只要该柔性套被充气，其充气部分就沿径向向外膨胀，且相对于肠内壁基本上保持静止。通常仅在该探针处或紧邻该探针处，该柔性套会相对于壁纵向移动。从而，该探针容易送进，且对胃肠道的损伤最小。为了除去该探针，该柔性套被排空，且被用于通过肛门拉回该探针...。
″在本发明其他的优选实施方案中，该柔性套置于紧缩状态，且通常在该探针内部或紧邻着该探针被折叠或卷曲。最优选地，被折叠或卷曲的探针置于该探针近侧部分的凹进部分中。随着该探针的送进，该柔性套逐渐退出其保存状态，且贴着内肠壁膨胀...。
″在本发明优选实施方案中，通过向柔性套充气来使探针穿过胃肠道进行送进，这样会减少或不需要在探针近侧端处(患者身体的外侧)施加机械力以插入探针。因此，本发明可减少或不需要对患者身体的任何部分施加集中、局部的压力，减少或不需要探针单元或其部件与患者身体之间的刮擦和摩擦，且可避免将流体或其他原料喷射到身体通道内″。
根据本发明优选实施方案，通过将本专利申请的技术与″Piston-actuated endoscopic steering system″申请及″Propulsion of aprobe in the colon using a flexible sleeve″申请中所述的技术相结合，可提供基本上进行所有移动(即工具-操作、转向和推进)的内窥镜，且其不需要公知的线缆或其他元件；所述线缆或其他元件有些时候会对胃肠道施加不希望有的力，和/或在操作过程中产生过大的摩擦力。
可以理解的是，尽管上述阐明了优选的实施方案，但本发明并不限于以上特别显示和描述的。相反地，本发明的范围包括以上所述各个特征的集合及子集，以及本领域所属技术人员通过阅读前述上述说明书可以得到的、但在现有技术中未公开的变型和修改。例如，虽然本发明优选实施方案描述了液压工具在胃肠道内的操作，但可以理解地，其也可用于其他体腔中。

Claims (19)

1.一种内窥装置，具有插进患者体内的远侧端和保留在患者体外的近侧端，该内窥装置包括：
近侧缸，其位于内窥装置近侧端的附近区域；
近侧活塞，其可滑动地容置在该近侧缸内；
远侧缸，其位于内窥装置远侧端的附近区域；
远侧活塞，其可滑动地容置在该远侧缸内；
用于容纳液体的管，其连接在近侧缸和远侧缸之间；及
工具，其被连接以由该远侧活塞的位移所致动，从而响应于该远侧活塞的位移对身体的组织或身体的内容物施加机械作用。
2.如权利要求1所述的内窥装置，其特征在于：该工具、该远侧缸、该远侧活塞和该管适合于穿过内窥镜的工作通道，从而使用该内窥镜来接近身体内的区域。
3.如权利要求1所述的内窥装置，其特征在于：该工具适合于接近患者胃肠道的一部分。
4.如权利要求1所述的内窥装置，其特征在于：该工具包括活组织检查工具。
5.如权利要求1所述的内窥装置，其特征在于：该工具包括治疗工具。
6.如权利要求1所述的内窥装置，其特征在于：
该远侧缸包括位于该远侧缸的各个侧面上的两个区域，
该管适合于与所述区域中的第一区域相连通，
所述区域中的第二区域被构造成使得，该远侧活塞在第一方向上的移动可改变第二区域中的流体压力，及
该远侧活塞与该远侧缸连接，从而响应于流体压力的变化在与第一方向相反的第二方向上经受力。
7.如权利要求1～6中任一项所述的内窥装置，其特征在于：该近侧活塞适合于手动操作。
8.如权利要求7所述的内窥装置，其特征在于：该内窥装置包括与该近侧活塞连接的连杆，其适合于便利该近侧活塞的手动操作。
9.如权利要求1～6中任一项所述的内窥装置，其特征在于：该工具与该远侧活塞连接，从而由于该近侧活塞的操作通过液体对该管加压来致动该工具。
10.如权利要求9所述的内窥装置，其特征在于：该工具包括钳子，及其中通过对该管加压来致动该工具以使该钳子关闭。
11.如权利要求9所述的内窥装置，其特征在于：该工具包括勒除器，及其中通过对该管加压来致动该工具以使该勒除器关闭。
12.一种内窥装置，具有插进患者体内的远侧端和保留在患者体外的近侧端，该内窥装置包括：
远侧活塞；
远侧缸，其中在该远侧缸内可滑动地容置有该远侧活塞，该远侧缸位于该内窥装置远侧端的附近区域，且该远侧缸具有邻近该远侧活塞的第一远侧端口和远离该远侧活塞的第二远侧端口；
工具，其被连接以由该远侧活塞的位移进行致动；
近侧活塞；
近侧缸，其中在该近侧缸内可滑动地容置有该近侧活塞，该近侧缸位于该内窥装置近侧端的附近区域，该近侧缸具有邻近该近侧活塞的第一近侧端口和远离该近侧活塞的第二近侧端口；及
第一管和第二管，其中该第一管将其中的一个近侧端口与其中的一个远侧端口相连接，且该第二管将其中的另一个近侧端口与其中的另一个远侧端口相连接，以使得：
(a)该近侧活塞的近侧移动可驱动液体通过其中的一个管而将正压力施加至该远侧活塞的第一侧，以使该远侧活塞在第一方向上位移，并对该工具进行致动以处于第一状态，及
(b)该近侧活塞的远侧移动可驱动液体通过其中的另一个管而将正压力施加至该远侧活塞的第二侧，以使该远侧活塞在第二方向上位移，并对该工具进行致动以处于第二状态。
13.如权利要求12所述的内窥装置，其特征在于：该工具、该远侧缸、该远侧活塞和该管适合于穿过内窥镜的工作通道，从而使用该内窥镜来接近身体内的区域。
14.如权利要求12所述的内窥装置，其特征在于：该工具适合于接近患者胃肠道的一部分。
15.如权利要求12所述的内窥装置，其特征在于：该工具包括活组织检查工具。
16.如权利要求12所述的内窥装置，其特征在于：该工具包括治疗工具。
17.如权利要求12～16中任一项所述的内窥装置，其特征在于：该近侧活塞适合于手动操作。
18.如权利要求17所述的内窥装置，其中该装置包括与该近侧活塞连接的连杆，其适合于便利该近侧活塞的手动操作。
19.一种内窥装置，具有插进患者体内的远侧端和保留在患者体外的近侧端，该内窥装置包括：
第一近侧缸和第二近侧缸，其置于该内窥装置近侧端的附近区域；
第一近侧活塞和第二近侧活塞，其可滑动地容置在各自的近侧缸内；
至少一个远侧缸，其置于该内窥装置远侧端的附近区域；
至少一个远侧活塞，其可滑动地容置在所述至少一个远侧缸内；
用于容纳液体的第一管，其连接在该第一近侧缸和所述至少一个远侧缸之间；
用于容纳液体的第二管，其连接在该第二近侧缸和所述至少一个远侧缸之间；
机械连杆，其连接到所述第一近侧活塞和第二近侧活塞上，以使得：(a)当该机械连杆在第一方向上位移时，移动该第一近侧活塞并在该第一管中产生正压力，及(b)当该机械连杆在第二方向上位移时，移动该第二近侧活塞并在该第二管中产生正压力；及
工具，其被连接以由所述至少一个远侧活塞的位移进行致动，从而响应于该远侧活塞的位移对身体组织或身体的内容物施加机械作用。
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