臺灣博碩士論文加值系統

隨著微創手術興起，內視鏡在手術中扮演了相當重要的角色，內視鏡就像醫生的雙眼，手術中醫生必須透過它才能了解病患體內的病情，並配合手術器械來達到醫療救治的效果。一個內視鏡的好壞取決於其操作是否順手，配合手術器械使用是否方便，手術時影像是否清晰，種種因素，但最重要的還是病人使用的需求。以往內視鏡以光纖內視鏡為主，而其造價昂貴，使其必須經消毒過後重複使用，而也因為這樣，使得一些消毒不乾淨或無法經消毒清除的病毒成為下一個使用者感染的因素，其中軟式內視鏡雖普遍改為電子式，但硬式內視鏡仍然使用以光學原理做為傳輸途徑之柱狀透鏡，其原因是因為電子式一般使用LEDs作為內視鏡照射之光源，但因為硬式內視鏡主要是用在大體腔手術中，故LED光源在不增加內式鏡的體積下難以提供足夠的亮度。本研究嘗試研發一可拋棄電子式非光纖內視鏡，過程中因為前端過熱不符合FDA 510K premarket notification，且光源也不足等問題，故針對此問題去做改善，其中增強光源部分本研究以外加光源為主，在不增加整體體積的情況下來達到改善光源的問題。而影像感測器晶片後置的方式來達到改善溫度過熱之問題。

Along with advancement of minimally invasive surgery, endoscopic surgery plays an important role. Surgeons need the endoscope to inspect the patient’s internal condition and with some endoscopic instruments for treatment.The quality of endoscope depends on many factors, including convenience, accuracy, resolution and patient’s requirement. Conventional flexible endoscope is not disposable and requires repeated use after some procedures of sterilization. Therefore, contamination between patients is always a potential problem.The study is an extension of prior study on the preliminary electrical non-fiberoptic endoscope. In our preliminary design, the temperature and brightness did not meet the requirement of premarket notification of 510K. We used some mechanisms to enhance the illumination without increasing the size and temperature of endoscope. The mechanisms included to move the processing chip backwards and applied a hinge structure to enhance the illumination. The overall efficacy and usefulness are tested in the animals.

摘　要 I
ABSTRACT II
致謝 III
目錄 IV
表目錄 VI
圖目錄 VII
第一章 緒論 1
1.1 背景與動機 1
1.2 目的 3
1.3 研究貢獻 6
第二章 內視鏡現況以及未來的發展 7
2.1 簡介 7
2.2 光纖內視鏡 7
2.3 電子式內視鏡 9
2.4 內視鏡近期發展 9
2.5 Electrical Non-Fiberoptic Endoscope(ENFE) 10
2.6 文獻回顧 11
第三章 實驗原理 23
3.1 電子式內視鏡系統基本架構 23
3.2 影像感測器的選用 23
3.3 一般電子式內視鏡光源 24
3.4 孟塞爾顏色系統(Munsell color system) 25
3.5 胸腔外科傳統內視鏡與ENFE之差別 25
第四章 實驗步驟 28
4.1 照度提升 28
4.2 LEDs排列設計 30
4.3 光照度量測 35
4.4 溫度量測 36
4.5 影像感測器之選用 37
4.6 影像品質檢測 38
第五章 結果與討論 41
5.1 LEDs排列方法之照度比較 41
5.2 溫度量測 47
5.3 影像感測模組測試 52
5.4 影像感測模組溫度測試 52
5.5 影像品質的評估 53
5.6 動物實驗 58
第六章 結論與未來展望 61
6.1 結論 61
6.2 未來展望 62
參考文獻 63

[1]M. Reuter, "Philipp Bozzini : The endoscopic idealist,"
Urologe A, vol.45, no. 9, 2006, pp. 1084-8, 1090-1.
[2]M. Reuter, "Maximilian Nitze : Obstetrician to urology,"
Urologe A, vol.45, no. 9, 2006, pp. 1076-1083.
[3]Jacobeus HC, "The practical importance of thoracoscopy in
surgery of the chest," Surg Gynecol Obstet, vol.4, 1922,
pp. 289-296.
[4]R. Loddenkemper, "Thoracoscopy--state of the art," Eur
Respir J, vol.11, no. 1, 1998, pp. 213-221.
[5]M.V. Braimbridge, "The history of thoracoscopic surgery,"
Ann Thorac Surg, vol.56, no. 3, 1993, pp. 610-614.
[6]P. Lee, P.N. Mathur, and H.G. Colt, "Advances in
thoracoscopy: 100 years since Jacobaeus," Respiration,
vol.79, no. 3, 2010, pp. 177-186.
[7]J. Bhatt, A. Jones, S. Foley, Z. Shah, P. Malone, D.
Fawcett, and S. Kumar, "Harold Horace Hopkins: a short
biography," BJU Int, vol.106, no. 10, 2010, pp. 1425-
1428.
[8]L. Morgenstern, "Fiberoptic endoscopy is 50! Basil I.
Hirschowitz, MD," Surg Innov, vol.13, no. 3, 2006, pp.
165-167.
[9]J. He, "History and current status of mini-invasive
thoracic surgery," J Thorac Dis, vol.3, no. 2, 2011, pp.
115-121.
[10]C.H. Chen, S.Y. Lee, H. Chang, H.C. Liu, and W.C. Huang,
"Technical aspects of single-port thoracoscopic surgery
for lobectomy," J Cardiothorac Surg, vol.7, 2012, p. 50.
[11]B. Zheng, E. Rieder, M.A. Cassera, D.V. Martinec, G.
Lee, O.N. Panton, A. Park, and L.L. Swanstrom, ''
"Quantifying mental workloads of surgeons performing
natural orifice transluminal endoscopic surgery (NOTES)
procedures," Surg Endosc, vol.26, no. 5, 2012, pp. 1352-
1358.
[12]P. Swain, R. Austin, K. Bally, and R. Trusty,
"Development and testing of a tethered, independent
camera for NOTES and single-site laparoscopic
procedures," Surg Endosc, vol.24, no. 8, 2010, pp. 2013-
2021.
[13]楊亮瑜，電子式非光纖內視鏡之研製，碩士論文，國立臺北科技大學，機電整
合研究所，台北市，2012。
[14]L.R. Kaplan, "Contamination of fiberoptic upper
intestinal endoscope," JAMA, vol.242, no. 5, 1979, p.
415.
[15]C.E. Hughes, R.L. Gebhard, L.R. Peterson, and D.N.
Gerding, "Efficacy of routine fiberoptic endoscope
cleaning and disinfection for killing Clostridium
difficile," Gastrointest Endosc, vol.32, no. 1, 1986, pp.
7-9.
[16]W.W. Bond, "Virus transmission via fiberoptic endoscope:
recommended disinfection," Md Med J, vol.37, no. 7, 1988,
pp. 497-498.
[17]R. Roosendaal, E.J. Kuipers, A.J. van den Brule, A.S.
Pena, A.M. Uyterlinde, J.M. Walboomers, S.G. Meuwissen,
and J. de Graaff, "Importance of the fiberoptic endoscope
cleaning procedure for detection of Helicobacter pylori
in gastric biopsy specimens by PCR," J Clin Microbiol,
vol.32, no. 4, 1994, pp. 1123-1126.
[18]G. McDonnell and P. Burke, "The challenge of prion
decontamination," Clin Infect Dis, vol.36, no. 9, 2003,
pp. 1152-1154.
[19]E. Zobeley, E. Flechsig, A. Cozzio, M. Enari, and C.
Weissmann, "Infectivity of scrapie prions bound to a
stainless steel surface," Mol Med, vol.5, no. 4, 1999,
pp. 240-243.
[20]L. Manuelidis, "Decontamination of Creutzfeldt-Jakob
disease and other transmissible agents," J Neurovirol,
vol.3, no. 1, 1997, pp. 62-65.
[21]R. Jancovici, F. Pons, J. Conan, F. Natali, and F.
Vaylet, "[Video-assisted thoracoscopic surgery]," Rev
Pneumol Clin, vol.50, no. 1, 1994, pp. 15-20.
[22]C.H. Chen, H. Chang, L.Y. Yang, H.C. Liu, T.T. Tsung,
and T.T. Hung, "A preliminary report of a disposable
electrical non-fiberoptic endoscope in thoracoscopic
surgery," Int J Surg, vol.10, no. 1, 2012, pp. 20-24.
[23]G. Lazopoulos, C. Kotoulas, J. Kokotsakis, C. Foroulis,
and A. Lioulias, "Diagnostic mini-video assisted thoracic
surgery. Effectiveness and accuracy of new generation 2.0
mm instruments," Surg Endosc, vol.16, no. 12, 2002, pp.
1793-1795.
[24]F.C. Wippermann, E. Beckert, P. Dannberg, R. Eberhardt,
A. Brauer, and B. Messerschmidt, "Low cost video
endoscopes with simplified integration," 2010.
[25]T. Kawahara, T. Takaki, I. Ishii, and M. Okajima,
"Development of a broad-view camera system for minimally
invasive surgery," 2010, pp.2810-2815.
[26]D. Covi, C. Cavallotti, M. Vatteroni, L. Clementel, P.
Valdastri, A. Menciassi, P. Dario, and A. Sartori,
"Miniaturized digital camera system for disposable
endoscopic applications," Sensors and Actuators, A:
Physical, vol.162, no. 2, 2010, pp. 291-296.
[27]H. Lehr, R. Dreyer Genannt Daweke, and S. Schrader,
"Image focusing in endoscopic systems," 2009, pp.87-90.
[28]W. Makishi, T. Matunaga, Y. Haga, and M. Esashi, "Active
bending electric endoscope using shape memory alloy coil
actuators," 2006, pp.217-219.