臺灣博碩士論文加值系統

顱內動脈瘤為一種腦血管疾病，因腦動脈受損而發生異常膨脹而發生。據統計，在美國統計有600萬人患有顱內動脈瘤，其中每年約有1%動脈瘤有破裂風險產生，並會引發出血性中風。目前治療顱內動脈方式以血管栓塞手術為主，在手術中醫生必須手動操控導線，在時間有限的情況下藉由X光將導線引入腫瘤病理位置，在手術過程中由於血管彎曲複雜，容易而造成過度摩擦，導致導線無法到達目標手術失敗，且因過度摩擦血管受損導致感染或併發症產生。為了避免栓塞手術中導線與血管產生過多摩擦及碰撞，本研究設計低成本且具有輔助手動控制導線系統，在導線尖端使用形狀記憶合金微型致動器能夠提升手術提升血管內導線自由度，有效降低手術時間，減少對血管摩擦造成感染與併發症發生率。結果顯示本研究微型致動器前端、後對最大彎取角度分別達到〖35.8〗^。、〖20.4〗^。以及最大橫向位移量可達5.95 (mm)。為了驗證本研究所使用的控制系統是否具備高靈敏度，將測試重複循環試驗，在結果中本研究所設計的微型致動器加熱5秒，達到最大偏轉角度，完全冷卻間隔時間10秒，驗證控制系統具有高靈敏度，可以在致動後迅速回復初始狀態。說明了本實驗之微型致動器具有微型化的尺寸、較佳的導線自由度、且具有高靈敏度的特性，可以縮短手術時間，並提升導線自由度在手術中經過錯綜複雜的血管中更能經過醫生手動操作達到病理位置。另外本研究為了提升手術標準化，而提出一種具有遠程控制導線系統，與微型致動化做整合，並藉由血管模型之實驗測試，將導線移動數據回傳至電腦上監控導線水平旋轉角度及位置，將結果量化出可信度數據足以應用於導管介入性治療，在未來可能設計出輔助翻轉微型致 動導線，能夠讓導線做不同方位偏轉角度，並可藉由數據分析能研發出輔助手動操控微型致動器並與三維成像路徑導引技術做結合，達到與血管實驗模型最佳偏轉角度、降低顯影劑量與X光照射時間，並整合系統提升手術標準化，應用於醫療資匱乏地區。

To sum up, this research proposes a method which is using shape memory alloy (SMA) embedded guidewire to control the micro-actuator for cardiovascular surgery. By this method, the tip of the embolization guidewire can be controlled precisely, that further increases the surgical accuracy and reducing surgery time at the same time. As the results, the system shows that (1) tip of the actuator has an optimal bending angle of 35.8° and end of the actuator has an optimal bending angle 20.4 a guidewire lateral displacement of 5.95 mm. and (2) during the heating process takes 5 seconds to allow the guidewire achieve maximum and achieve initial state in the cooling process for 10 seconds. This performance indicates that this system has an effective control angle and high sensitivity. Moreover, for the ease in standardization of surgery, we use the catheter assisted system. To test the efficacy of proposed device, the system was in-vitro tested with patient-specific vascular network model that demonstrate its appraised feasibility during catheter interventions.

摘要 II
致謝 IX
目錄 X
圖目錄 XIII
表目錄 XV
第一章 摘要 1
1.1 研究背景 1
1.2 顱內動脈瘤文獻回顧 3
1.2.1 顱內動脈瘤 3
1.2.2 顱內動脈瘤破裂 4
1.2.3 顱內動脈瘤治療方法 6
1.2.4 外科夾除手術 8
1.2.5 血管栓塞手術 9
1.3 可操縱式導線文獻回顧 11
1.3.1 可操作導管致動分類 11
1.3.2 磁致動 13
1.3.3 電致動 14
1.3.4 熱致動 15
1.3.5 液壓室致動 16
1.3.6 機械電纜致動 17
1.4 研究目的 24
第二章 研究方法 25
2.1 形狀記憶合金 25
2.2 微型致動器製程 26
2.3 脈波寬度調變與其應用 28
2.4 量化微型致動器 30
2.5 材料力學理論與數值模擬分析 32
2.6 遠端控制系統 35
2.7 血管模型實驗 37
第三章 結果與討論 39
3.1 形狀記憶合金微型致動器分析 39
3.2 占空比分析 42
3.2.1 導線偏轉角分析 42
3.2.2 微型致動器轉角分析 45
3.3 材料力學理論與數值模擬結果 48
3.4 血管模型試驗 49
第四章 結論與未來展望 51
4.1 結論 51
4.2 未來展望 53
參考文獻 54

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