人工肛门括约肌系统关键技术及实验研究
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摘要
肛门失禁指四岁以上患者出现反复发生的不能控制排便的症状,并持续一个月以上。由于该病症的特殊性,病人难以启齿,因此该病例数目往往被低估,所以研发一种隐蔽、可靠的植入式人工肛门括约肌系统至关重要。美国、日本、英国、德国等都对人工肛门括约肌进行了研究,然而存在不足,因此,开展新型的人工肛门括约肌系统研究具有十分重要的意义。
本论文依托国家自然科学基金项目“原位植入式人工肛门括约肌重建理论及其关键技术研究”(编号:30800235)、教育部博士点基金新教师基金“基于经皮供能的反馈式人工肛门括约肌实验研究”(编号:20070248094)和上海交通大学青年教师基金“反馈式人工肛门括约肌系统预研”(编号:06DBX006),对人工肛门括约肌重建及其关键技术进行了深入研究。
论文提出了人工肛门括约肌系统的设计原理,通过传感器、单片机、无线通信和微执行机构来分别模拟人体肛门直肠神经、大脑中枢神经、神经信号传输和肛门括约肌的功能。从总体上给出了体内装置和体外装置的结构,并分别对此设计的关键点进行了攻关研究。
论文着重介绍该系统设计的关键技术。首先,在微执行机构上提出了三种新型微型泵:滚轮式微型泵、凸轮式微型泵和注射式微型泵。阐述了各种微型泵的工作原理和优劣,比较了工作效率。其次,在经皮能量传输上建立了串联谐振电路和并联谐振电路效率模型,分析了影响传输效率的因素。第三,在肛门直肠动力学的研究中,提出了一种血液流速与压强的关系模型。此外对直肠感知功能实现、单片机及无线通讯模块进行了研究设计。
论文通过三方面实验来论证该系统的可实施性。微型泵实验包括微型泵输出力、工作时间的测定以及工作电压的选择。经皮能量传输实验讨论了能量传输效率与线圈轴向间距、径向间距、夹角、负载之间的关系。人工肛门括约肌系统的模拟实验研究了阈值设定这一难点问题。
最后,论文总结了该系统功能上的创新,尤其突出了微型执行机构,经皮能量传输,并提出了今后的改进方向,为将来的研究提供了丰富的素材,打下了扎实的基础。
Fecal incontinence refers to the symptoms that people over four years old lose control of defecation repetitively for more than one month. The number of the patients is usually underestimated as a result of embarrassment and unwillingness to discuss the problem with their doctors. Therefore, it is important to develop an invisible, reliable and implantable artificial anal sphincter system. This problem has attracted many researchers in America, Japan, Britain and Germany. However, the systems they devised have shortcomings, so a novel artificial anal sphincter system is of great importance to be developed.
This thesis is funded by National Natural Science Foundation Project“Implantable in-situ Artificial Anal Sphincter’s Reconstruction Theory and its Critical Technology”(Granted Number: 30800235), Doctoral Fund Young Faculty Fund of Ministry of Education Project“Research on Experiments of Feedback Artificial Anal Sphincter System Based on Transcutaneous Power Transmission”(Granted Number: 20070248094) and Young Faculty Fund of Shanghai Jiaotong University Project“Pre-research of Feedback Artificial Anal Sphincter System”(Granted Number: 06DBX006). It studies on the reconstruction and the critical technology of artificial anal sphincter.
This thesis proposes the design principle of artificial anal sphincter system, which is based on the sensor module, the microcontroller module, the wireless communication module and the micro-implementation module respectively simulating anorectal nerve, cerebral central nerve, nerve signal transmission and anal sphincter. It introduces the structure of in-vivo and in-vitro devices and studies the critical technology in the design.
The author emphasizes on the critical technology by first proposing three kinds of novel micro-pumps including wheel-based micro-pump, cam-type micro-pump and injection micro-pump. This thesis elaborates their working principle, analyzes their pros and cons and compares their efficiency. Secondly, in terms of transcutaneous power transmission, the thesis establishes the efficiency model of Serial Resonant Circuit and Parallel Resonant Circuit and analyzes the factors influencing the power transmission efficiency. Thirdly, as to the research on anorectum dynamics, the thesis proposes a model between blood flow rate and pressure. Besides, it studies the realization of rectum sensation and design of microchip and wireless communication module.
This thesis verifies the feasibility of the system by experiments from three aspects. The experiments of micro-pump includes test of the output force and operating time and the selection of operating voltage. The experiments of transcutaneous power transmission discuss the influence of the axial distance, the radial distance and the angel between the two coils and the load resistance on the power efficiency. The overall system experiment analyzes the crux of pressure threshold selection.
In conclusion, the thesis puts forward the innovation in this system with a focus on micro-implementation module and transcutaneous power transmission and their improvement potential. It lays a solid foundation and provides rich materials for future research.
本论文依托国家自然科学基金项目“原位植入式人工肛门括约肌重建理论及其关键技术研究”(编号:30800235)、教育部博士点基金新教师基金“基于经皮供能的反馈式人工肛门括约肌实验研究”(编号:20070248094)和上海交通大学青年教师基金“反馈式人工肛门括约肌系统预研”(编号:06DBX006),对人工肛门括约肌重建及其关键技术进行了深入研究。
论文提出了人工肛门括约肌系统的设计原理,通过传感器、单片机、无线通信和微执行机构来分别模拟人体肛门直肠神经、大脑中枢神经、神经信号传输和肛门括约肌的功能。从总体上给出了体内装置和体外装置的结构,并分别对此设计的关键点进行了攻关研究。
论文着重介绍该系统设计的关键技术。首先,在微执行机构上提出了三种新型微型泵:滚轮式微型泵、凸轮式微型泵和注射式微型泵。阐述了各种微型泵的工作原理和优劣,比较了工作效率。其次,在经皮能量传输上建立了串联谐振电路和并联谐振电路效率模型,分析了影响传输效率的因素。第三,在肛门直肠动力学的研究中,提出了一种血液流速与压强的关系模型。此外对直肠感知功能实现、单片机及无线通讯模块进行了研究设计。
论文通过三方面实验来论证该系统的可实施性。微型泵实验包括微型泵输出力、工作时间的测定以及工作电压的选择。经皮能量传输实验讨论了能量传输效率与线圈轴向间距、径向间距、夹角、负载之间的关系。人工肛门括约肌系统的模拟实验研究了阈值设定这一难点问题。
最后,论文总结了该系统功能上的创新,尤其突出了微型执行机构,经皮能量传输,并提出了今后的改进方向,为将来的研究提供了丰富的素材,打下了扎实的基础。
Fecal incontinence refers to the symptoms that people over four years old lose control of defecation repetitively for more than one month. The number of the patients is usually underestimated as a result of embarrassment and unwillingness to discuss the problem with their doctors. Therefore, it is important to develop an invisible, reliable and implantable artificial anal sphincter system. This problem has attracted many researchers in America, Japan, Britain and Germany. However, the systems they devised have shortcomings, so a novel artificial anal sphincter system is of great importance to be developed.
This thesis is funded by National Natural Science Foundation Project“Implantable in-situ Artificial Anal Sphincter’s Reconstruction Theory and its Critical Technology”(Granted Number: 30800235), Doctoral Fund Young Faculty Fund of Ministry of Education Project“Research on Experiments of Feedback Artificial Anal Sphincter System Based on Transcutaneous Power Transmission”(Granted Number: 20070248094) and Young Faculty Fund of Shanghai Jiaotong University Project“Pre-research of Feedback Artificial Anal Sphincter System”(Granted Number: 06DBX006). It studies on the reconstruction and the critical technology of artificial anal sphincter.
This thesis proposes the design principle of artificial anal sphincter system, which is based on the sensor module, the microcontroller module, the wireless communication module and the micro-implementation module respectively simulating anorectal nerve, cerebral central nerve, nerve signal transmission and anal sphincter. It introduces the structure of in-vivo and in-vitro devices and studies the critical technology in the design.
The author emphasizes on the critical technology by first proposing three kinds of novel micro-pumps including wheel-based micro-pump, cam-type micro-pump and injection micro-pump. This thesis elaborates their working principle, analyzes their pros and cons and compares their efficiency. Secondly, in terms of transcutaneous power transmission, the thesis establishes the efficiency model of Serial Resonant Circuit and Parallel Resonant Circuit and analyzes the factors influencing the power transmission efficiency. Thirdly, as to the research on anorectum dynamics, the thesis proposes a model between blood flow rate and pressure. Besides, it studies the realization of rectum sensation and design of microchip and wireless communication module.
This thesis verifies the feasibility of the system by experiments from three aspects. The experiments of micro-pump includes test of the output force and operating time and the selection of operating voltage. The experiments of transcutaneous power transmission discuss the influence of the axial distance, the radial distance and the angel between the two coils and the load resistance on the power efficiency. The overall system experiment analyzes the crux of pressure threshold selection.
In conclusion, the thesis puts forward the innovation in this system with a focus on micro-implementation module and transcutaneous power transmission and their improvement potential. It lays a solid foundation and provides rich materials for future research.
引文
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[2] Mavrantonis C, Wexner SD: A clinical approach to fecal incontinence. Journal of Clinical Gastroenterology, 1998, 27(2):108-21.
[3] Bharucha AE, Zinsmeister AR, Locke GR, Schleck C, McKeonK, Melton LJ. Symptoms and quality of life in community women with fecal incontinence. Clinical Gastroenterology Hepatology, 2006, 14:1004-1009.
[4] Enck P Bielefeldt K, Rathmann W et al, Epidemiology of faecal incontinence in selected patient groups. Int J Colorect Dis, 1991, 6:143-146.
[5] Drossman DA, Zhming L, Andruzzi E, et al. U. S. householder survey of functional gastrointestinal disorders. Dig Dis Sci, 1993, 38: 156921580.
[6] Furner S, Cautley E, Norton N, Nelson R Community based prevalence of anal incontinence. JAMA, 1995, 274:559.
[7] Caushaj P, Madoff R, Williams JG, Fecal incontinence. New England Journal of Medicine, 1992, 326:1002-1006.
[8] Jesudason V, Furner S, Nelson R. Fecal incontinence in Wisconsin nursing homes: prevalence and associations. Dis Colon Rectum, 1998,41:1226.
[9] Macmillan AK, Merrie AE, Marshall RJ, et al. The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature. Dis Colon Rectum, 2004, 47(8):1341-9.
[10] William E. Whitehead, et al. Treatment Options for Fecal Incontinence, Dis Colon Rectum, 2001, January: 131-142.
[11] J. Bauch, M. Betzler, H.-J. Oestern. Diagnostik und Therapie der Stuhlinkontinenz, Chirurg, 2008, 79:379-389.
[12] J.M. Devesa, P. López-Hervás, R. Vicente, A. Rey, J. Die, A. Fraile. Total anorectal reconstruction: a novel technique, Tech Coloproctol, 2005, 9:149-152.
[13] Susan Galandiuk, Leslie A. Roth, Quincy J. Greene, Anal incontinence-sphincter ani repair: indications, techniques, outcome, Langenbecks Archives of Surgery, 2008, DOI10.1007/s00423-008-0332-4.
[14]卢杰,杨暘.肛门失禁的护理综述,医药世界, 2005年第5期: 62-63.
[15]李炎冬.肛门失禁的评估与治疗,结直肠肛门外科, 2006年第12卷第4期: 263-266.
[16] Chetwood CH. Plastic operation for restoration of the sphincter ani with report of a case. Indian Medical Record, 1902, 23:70.
[17] Williams NS, Patel J, George BD, Hallan RI, Walikins ES. Development of an electrically stimulated neoanal sphincter. The Lancet, 1991, 338:1166-9.
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