摘 要
泌尿道結石和腎臟結石是泌尿系統最常見的疾病。輸尿管軟鏡取石手術、經皮穿刺腎臟造廔碎石取石手術、逆行性腎臟內取石手術以及體外震波碎石手術更是現在最常治療結石的方式，而我們台灣健保新制度自開始辦理以來，一直是論病例計酬之方式來讓病患支付醫療費用，經皮穿刺腎臟造廔碎石取石手術的支付點數也為給付項目之一，但也因為為開放性手術，術中失血量及術後照護時間也相對較長，故在醫學求精求益的精神下，逐漸往微創手術的方向前進。
本研究除瞭解以目前經皮穿刺腎臟造廔碎石的取石頭手術的手術後結果外，更進一步研究如何借由單拋棄式腎臟軟鏡的推廣，來提高南台灣結石手術的廓清率、降低醫院的醫療成本，更降低病患的感染率，進而提高病患的就醫安全之相關研究。
本研究以南部某醫學中心為例，說明如何利用單拋棄式腎臟軟鏡來提高結石手術的廓清率，降低醫院的醫療成本，同時降低病患的術後感染率，進而提高病患的就醫安全。 此外，也針對國內醫療環境以及醫院採購決策流程，初步制定「先大後小、先私後公」的推廣策略。

Abstract
Ureter stones and kidney stones are the most common diseases in urology department. Ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (ESWL) are the most common treatments for stones. Also, the Health Insureance System in our country is by case payment, and percutaneous nephrolithotomy is coverd by health insurance system. However, percutaneous nephrolithotomy has some weakness. For instance, it will cause large amount of bleeding, also longer recovery time is needed after having percutaneous nephrolithotomy surgery. Therefore, under the spirit of improvement, the mirco-invasive surgery become the mainstream.
This research first used survey approach to understand the current status of micro-invasive surgery with single-use digital flexible ureteroscope, which is believe can improve the stone free rate, lower the medical cost, decrease the infection risk for patients after surgery, and improve the safety for patients. The improvement of medical technique allow patients to be better treated. Therefore, infection risk can be decreased, and the quality of medical can be improved with the use of single-use flexible ureteroscope. Moreover, the medical cost can be lower by using single-use flexible ureteroscope.
Through the research, we suggest the way to expand the market size and how to give patient a better option. Through this research, we hope that case company can be benefited by the proposed marketing strategy and surgerions can pick a better treatment to deal with complex kidney stones.

目錄
論文審定書 i
誌 謝 ii
摘 要 iii
Abstract iv
目錄 v
圖次 vii
表次 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究流程 3
第四節 研究範圍與限制 9
第二章 文獻探討 10
第一節 臺灣腎結石現況 10
第二節 腎臟結石成因 11
第三節 概述腎臟結石治療方法 13
第三章 產業及治療現況 18
第一節 高醫中和醫院之願景及特色醫療 18
第二節 創新醫材供應商簡介 20
第三節 腎臟結石手術處理方式 22
第四章 研究設計 31
第一節 研究結構 31
第二節 研究模式 32
第三節 分析架構：SWOT以及五力分析模式 35
第五章 實證分析 38
第一節 單拋棄式腎臟軟鏡之優點分析 38
第二節 單拋棄式腎臟軟鏡公司的推廣策略分析 43
第三節 實證結果彙整 50
第六章 結論與建議 54
第一節 結論 54
第二節 學術建議 56
第三節 管理意涵 56
參考文獻 58

考文獻
一、中文
1. 李和惠、黃鈺雯、林麗秋(2012)．泌尿系統疾病病人之護理．於胡月娟總校閱．內外科護理
2. 彭定凱(2017)，線上分析儀系統整合商經營策略個案之研究
3. 司徒達賢，2013，管理學的新世界，台北:天下文化。
4. 萬文隆，2004，「深度訪談在質性研究中的應用」，生活科技教育月刊，37 卷 4 期， 1~7。
5. 林淑馨，2010，質性研究:理論與實務，台北:巨流。
二、英文
1. Arkoff, A. 1981. Adjustment and Mental Health. New York: McGraw-Hill.
2. Matlaga, BR. The single use flexible ureteroscope: what is its place in stone management? Disposable/Single Use vs. Reusable Scope Plenary Session presented at The World Congress of Endourology, 15 September 2017; Vancouver, British Columbia, Canada.
3. Molina W, Warncke J, Donalisio da Silva R et al. Cost analysis of utilization of disposable flexible ureteroscopes in high risk for breakage cases. Poster session PD53-03 presented at the American Urological Association Annual Meeting, May 2018; San Francisco, California.
4. User HM, Hua V Blunt LW, et al. Performance and durability of leading flexible ureteroscopes. J Endourol.2004 Oct;18(8):735-8.
5. Strategic Health Resources. Aggregate figures include the costs of patient notification testing, incident investigation, medical malpractice defense, settlement/erdict, loss of volume. National SGNA Congress Presentation 2012.
6. Eisner B. Evaluating the image quality of a novel single-use digital flexible ureteroscope. J Endourol. 2015;29(1):A348.
7. Leveillee RJ, Kelly EF. Impressive performance: new disposable digital ureteroscope allows for extreme lower pole access and use of 365 um Holmium laser fiber. J Endourol Case Rep. 2016;2(1):114-6.
8. Usawachintachit M, Isaacson DS, Taguchi K, et al. A prospective case-control study comparing LithoVue, a single-use, flexible disposable ureteroscope, with flexible, reusable fiber-optic ureteroscopes. J Endourol. 2017 May;31(5):468-75.
9. Ofstead CL, Heymann OL, Quick MR, et al. The effectiveness of sterilization for flexible ureteroscopes: A real-world study. Am J Infect Control. 2017 Aug 1;45(8):888-95.
10. Portman G, Stites J, Press B, et al. Clinical assessment of the durability of a single-use digital flexible ureteroscope for the treatment of large stone burden or extensive upper tract urothelial carcinoma. Poster Session MP34-20 presented at The World Congress of Endourology, September 2017; Vancouver, British Columbia, Canada.
11. Hession SM. Endoscope disinfection by orthophthaladeyde in a clinical setting: an evaluation of reprocessing time and costs compared with glutaraldehyde. Gastroenterol Nurs. 2003 May-Jun;26(3):110-4.
12. Druskin S, Ziemba J, Cao S, et al. Ureteroscope reprocessing: a time-in-motion study of a lengthy journey. J Urol. 2016 Apr:195(4 Suppl); e509-10.
13. Proietti S, Somani B, Sofer M, et al. The “Body Mass Index” of flexible ureteroscopes. J Endourol. 2017 Oct;31(10):1090-5.
14. Biligere S, Durai P, Heng CT, et al. C-10021. Modified ergonomic lithotripsy (MEL) with LithoVue: Maximising ergonomics in flexible ureterorenoscopy (FURS). BJU Int. 2017 Apr;119(S4):7.
15. Davis NF, McGrath S, Quinlan M, et al. Carbon footprint in flexible ureteroscopy: a comparative study of the environmental impact of reusable and single use ureteroscopes. J Endourol. 2018 Mar;32(3):214-7.
三、網路
1. NHS-overview of kidney stones: https://www.nhs.uk/conditions/kidney-stones/
2. NHS- causes of kidney stones: https://www.nhs.uk/conditions/kidney-stones/causes/
3. NHS- treatment of kidney stones: https://www.nhs.uk/conditions/kidney-stones/treatment/
4. 經理人，SWOT分析，讓「生意頭腦」全速運轉: https://www.managertoday.com.tw/glossary/view/15
5. 經理人，五力分析：剖析產業環境，掌握企業優勢: https://www.managertoday.com.tw/articles/view/1740
6. LithoVue: Single-use Digital Flexible Ureteroscope: https://www.bostonscientific.com/content/gwc/en-US/products/Ureteroscopes/LithoVue.html