| 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(MIS)、肝穿刺生檢(Liver Biopsy)、下背痛(Low Back Pain)
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.
Key words: Minimally Invasive Surgery, Liver Biopsy, Low-Back
Pain
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