臺灣博碩士論文加值系統

近年來微創手術的發展趨勢在思考如何更進一步地降低手術之侵襲
性，因此、經自然孔道內視鏡手術（Natural Orifice Transluminal Endoscopic Surgery，簡稱NOTES）的概念即孕育而出，因此，本研究以胃部手術為對象，提出以利用層塊（Sector）堆疊成一簡易操縱器（Coarse Manipulator）的方式，搭配軟管使之彎曲，驗證其能達到良好之操作性；並設計與最佳化內視鏡鉗夾之幾何外型與夾持力使其不刺穿胃壁卻能有效的封閉切口。為了得到胃之相當機械性質，本研究亦利用單軸滑軌將針頭以Z 軸方向向下移動刺穿胃壁，探討在不同針頭直徑下，刺穿胃壁所需要之力，建立資料庫以提供有限元素模擬軟體（ANSYS），分析當內視鏡鉗夾住胃壁時之應
力分佈，並最佳化針頭之高度、圓角大小，以達到最佳的尺寸參數；除此之外、利用快速原型（OBJET EDEN 350V）製作所設計之模型並組裝後、進行離體豬胃實驗驗證其功能的可行性與穩定性，實驗結果顯示胃壁切口不會因張力而造成二次開放。

Natural orifice transluminal endoscopic surgery (NOTES) is an experimental surgical technique whereby "scarless" abdominal operations can be performed with an endoscope passed through a natural orifice (mouth, urethra, anus, etc.) then through an internal incision in the stomach, vagina, bladder or colon, thus avoiding any external incisions or scars. This technique has been used for diagnostic and therapeutic procedures in animal models, including transgastric (through the stomach) organ removal. The disadvantages of NOTES are 1.) difficulties in achieving safe enterotomy closure or a leak proof anastomosis, it necessitates performing more operations compared to open or laparoscopic operations in order to obtain the skills for performing these operations, and 2.) difficulties of acquiring satisfactory endoscopic vision due to lack of advanced technology. Therefore, the aims of this research are to design a flexible and friendly used control mechanism for NOTES and to improve the safety of incision closure by optimizing the tying force of endoclip. Two approaches were conducted in this study. One is to obtain the mechanical properties of swine’s stomach with regarding to varied thickness and another is to simulation the tying force of endoclip by using ANSYS software. The designed device was then fabricated and assembled by using a rapid prototyping system (Objet Eden 350V). A practical test of assembled device was in-vivo performed with a swine’s stomach. Consequently, it was proved that it can safety enclose the incision without any leaking.

摘要...................................................i
Abstract ..............................................ii
致謝...................................................iii
目錄...................................................iv
表目錄.................................................vii
圖目錄.................................................viii
第一章緒論.............................................1
1-1 前言...............................................1
1-2 NOTES 相關文獻回顧.................................4
1-3 Endoscopic Tools 文獻回顧..........................14
1-4 快速原型系統簡介...................................17
1-5 研究動機與目的.....................................19
第二章設計與方法.......................................20
2-1 儀器設計...........................................20
2-1-1 簡易操縱結構之設計...............................20
2-1-2 夾鉗之設計.......................................23
2-2 內視鏡夾鉗之夾持步驟...............................31
第三章實驗流程與實驗設備...............................36
3-1 實驗流程...........................................36
3-2 實驗設備...........................................38
3-2-1 單軸滑台.........................................38
3-2-2 荷重元控制器（Load-Cell）與NTS-1280 訊號放大器...40
3-2-3 DAQ-數位擷取卡...................................42
3-2-4 快速成型機OBJET EDEN 350V之簡介..................44
3-3 刺穿豬胃實驗.......................................45
3-4 數值模擬方法.......................................46
3-4-1 模擬條件與參數特性...............................46
第四章實驗結果與討論...................................51
4-1 刺穿豬胃實驗.......................................51
4-2 夾持豬胃胃壁之模擬結果.............................57
4-3 原型之製作與離體實驗...............................64
第五章結論.............................................70
未來展望...............................................71
參考文獻...............................................72
Extension Abstract.....................................76
簡歷...................................................81

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