- 學位論文
胃造口手術穿刺針之改良設計研究
A Modified Design of the Puncture Needle for Percutaneous Gastrostomy
摘要
對於有持續性吞嚥困難的病人，目前已漸漸採用經皮胃造口手術(Percutaneous Endoscopic Gastrostomy, PEG)以供給營養、水分和藥物。目前較為常見的手術方式有外科胃造口術(Surgical Gastrostomy)、利用經皮內視鏡的胃造口術(俗稱PEG)以及利用放射線透視或超音波導引之胃造口術。傳統的穿刺方法大部份是利用手推的方式將穿刺針刺入胃部，然而人類的胃部甚為強韌，雖然可以利用充氣使胃部膨脹的方式來降低穿刺難度，但有時由於手推的瞬間力道不足，仍然難以突破胃壁。 目前雖已有彈射式組織採樣的穿刺針產品，但不適用於經皮胃造口手術，而且會發生內針無法退針的問題。因此本研究提出一種用於經皮胃造口手術之彈射式穿刺針的改良設計，協助解決手推的瞬間力道不足的問題。本研究先藉由豬胃體外穿刺實驗找出較佳的穿刺器械，並採用彈簧進行所需的機構設計，研發設計出一種改良型的同步彈射式穿刺針。 此一改良型穿刺針已利用3D列印而完成打樣製作，並設計以豬胃為對象的穿刺實驗測試，結果顯示其成功率達到87%以上，符合醫療上對此產品的要求，初步證實此新型設計的可行性。此研發之彈射式同步彈射式穿刺針若輔以現有的CT影像導引功能，除了可解決手推式穿刺針力量上不足的問題，亦可解決目前彈射式組織採樣穿刺針的內針則無法退針外，若再輔以定位裝置而固定穿刺時之方向和角度，亦可增加一次性穿刺成功之機率，大大降低了手術風險。
並列摘要
For patients of persistent dysphagia, it has been gradually applied percutaneous gastrostomy surgery to supply nutrients, water and medicines. Currently, the most frequent surgical method includes gastrostomy surgery, gastrostomy percutaneous endoscopic perspective and the use of radiation or guided by ultrasound in gastrostomy. Most of the traditional methods to puncture are to push the puncture needle into the stomach. Human’s stomach, however, is very leathery. Although one can use swell way to make stomach inflatable to reduce the puncture difficulty, but sometimes it is still difficult to break through the stomach due to the lack of push force at the right moment. Although there are tissue-sampling catapult-style needle products, they are not suitable for percutaneous gastrostomy surgery, and it sometimes occurs that the inner needle can't be withdrawn. Therefore, this study presents an improved design of the catapult-style surgical needle for percutaneous gastrostomy to help solve the problem of insufficient strength at the moment of instant hand-push. In this study, firstly the punctured experiments on pig stomach in vitro are taken to find better equipment for puncturing, and then springs are applied in the mechanical design for the modified catapult-style synchronous surgical needle. The prototype of this modified needle has been done via 3D printer. The puncture experimental tests on pig stomachs have also completed. The results show the success rate is over 87% which satisfies the requirements for such products. Therefore, the preliminary results have confirmed its feasibility of this design. If this novel catapults catapult-type synchronous needle is aided by the image-guided function of CT, it not only can solve the problem of insufficient strength problem of hand-push, but also the problem of the inner needle can't be withdrawn. If it can be additionally aided by positioning device to obtain the fixed orientation of needle for puncturing, it definitely could increase the probability of success at the first puncturing and greatly reduce the risk of surgery.
參考文獻
延伸閱讀
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