適用於穿刺手術之醫療機械手臂設計與臨床適用性分析

Design of Medical Robot for Biopsy and Analysis of Its Clinical Applicability

林書玄(Shu-Hsuan Lin)

指導教授 ： 楊宏智

國立臺灣大學/工學院/機械工程學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.10455

摘要

近年來微創手術廣為醫界所重視，由於微創手術在手術時所造成的傷口小，對病患術後的復原與降低手術併發症的發生均有良好的成效。然而，在微創手術的執行需藉由醫學影像作為手術之引導，由於醫學影像導航之需求，國內外相繼開發醫學影像導航系統，其中以機械手臂作為醫學影像導航是不錯的方法。本研究針對穿刺微創手術進行機械手臂的設計開發，藉由臨床醫學文獻的收集確認穿刺手術的主要需求，並利用臨床手術之需求訂定醫療機械手臂之規格，進而完成穿刺醫療機械手臂之設計，作為機械手臂醫學影像導航系統所使用。
臨床醫學文獻的收集，主要針對國人常執行的穿刺手術如:肝穿刺生檢、下背痛的治療(神經根阻斷、小面關節注射)進行臨床需求的訂定，並著手設計穿刺醫療機械手臂。為了瞭解本機械手臂於肝穿刺手術與下背痛的治療之適用性，根據手術執行須經由特定的穿刺方位與穿刺角度執行的特性，建立一套Working Cone的概念，用於描述機械手臂在各方位角執行穿刺角度之能力分析。
最後利用Working Cone的概念，結合醫學影像手術規劃軟體進行實際手術穿刺方位與穿刺角度的量測，取得臨床手術實際數據，作為本穿刺醫療機械手臂之臨床適用性分析與相關探討。

關鍵字

微創手術 ； 肝穿刺生檢 ； 下背痛

並列摘要

In recent years, minimally invasive surgery has received wide attention. Only small injures incur by the surgery, the complication can be greatly reduced. Accordingly, the patient can recover sooner. However, minimally invasive surgery requires medical images as a navigation guide in the operation. The high demand for the medical imaging navigation system has led active researches in this field. Among these research developments, an integration of robot arm with medical image navigation is found an attractive option. In this study, comprehensive biopsy clinical literatures were searched and analyzed. Meanwhile clinical survey was conducted to verify the medical robot specifications on which following design is based.
Biopsy clinical literature shows that the treatment is mainly aiming at Liver Biopsy inspection and Low-Back Pain. The biopsy medical robot made in this research was then evaluated from the viewpoints of these applications. To understand the medical robot, The Working Cone concept was proposed as a means to describe the medical robot ability during the biopsy surgery. This method was applied to test the device applicability in the situations for treatment of Liver Biopsy and Low-Back Pain. Finally, the Working Cone method was combined with the surgery planning system to measure the direction and the angle of biopsy in the surgery. The data obtained are discussed its clinical values in practice.

並列關鍵字

Minimally Invasive Surgery ； Liver Biopsy ； Low-Back Pain

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