相信許多人都會有疑問，電子內窺鏡最貴，為什么還要做成一次性的？為什么能夠做成一次性的？讓我們一起來扒一扒它的出生，看一看它的經歷。

　　Many people may wonder why electronic endoscopes, which are the most expensive, are still made disposable? Why can it be made disposable? Let's take a look at its birth and its experiences together.

　　在內窺鏡200多年的發(fā)展歷程中，出現(xiàn)了幾次重大技術突破，將內窺鏡帶入了不同的發(fā)展階段：整體經歷了早期硬管式內窺鏡、半可屈式內窺鏡、纖維內窺鏡、CCD電子鏡以及CMOS電子鏡四個階段。還有些人會把膠囊內窺鏡列入第五階段，這是我們現(xiàn)階段正在經歷的轉變，能不能列為第五階段還有待商榷。所以，在此我就把膠囊內窺鏡列入創(chuàng)新發(fā)展里。同樣，許多其他新技術也列入該類進行討論。

　　In the more than 200 years of development of endoscopes, there have been several major technological breakthroughs that have brought endoscopes into different stages of development: they have gone through four stages: early rigid tube endoscopes, semi flexible endoscopes, fiber endoscopes, CCD electronic microscopes, and CMOS electronic microscopes. Some people still classify capsule endoscopes as the fifth stage, which is a transformation we are currently experiencing. Whether it can be classified as the fifth stage remains to be discussed. So, I will include capsule endoscopy in the innovative development here. Similarly, many other new technologies are also included in this category for discussion.

　　01內窺鏡的發(fā)展歷程

　　The Development History of 01 Endoscope

　　第一階段：光學硬鏡、半屈式內鏡（1806年起） 1806年，德國醫(yī)生Philip Bozzini在病人的肛門內插入一根硬管，借助于蠟燭的光亮，觀察膀胱和直腸內部病變，他將其稱為"LICHTLEITER"，這被認為是內窺鏡發(fā)展史的開端。但當時的人們并不理解這種檢查方法， Bozzini 也因他的“好奇心”受到維也納 醫(yī)學院的處罰。第一次將"LICHTLEITER”運用于人體的是法國外科醫(yī)生 Desormeaux因此他被許多人譽為“內窺鏡之父”。他的“LICHTLEITER”是以燒煤油和松節(jié)油的燈為光源，燈的上方帶有煙囪并用透鏡將光線聚集以增加亮度，可想而知灼傷是進行這種檢查時的主要并發(fā)癥。雖然這種內窺鏡可以到達胃，但光線太暗，所以“LICHTLEITER”主要用于檢查泌尿系方面的疾病。1868 年，Desormeaux 和 Segelar 第一次在一篇文章中使用“內窺鏡”一詞。Philip Bozzini的“LICHTLEITER”

　　In 1806, German doctor Philip Bozzini inserted a hard tube into the patient's anus and used the light of a candle to observe the internal lesions of the bladder and rectum. He called it the "LICHTLEITER", which is considered the beginning of the history of endoscopic development. But at that time, people did not understand this examination method, and Bozzini was also punished by the Vienna Medical School for his "curiosity". The first time the "LICHTLEITER" was applied to the human body was by French surgeon Desormeaux, who is widely known as the "father of endoscopes". His "LICHTLEITER" uses a kerosene and turpentine burning lamp as a light source, with a chimney above the lamp and a lens to concentrate the light to increase brightness. It can be imagined that burns are the main complication of this examination. Although this endoscope can reach the stomach, the light is too dim, so "LICHTLEITER" is mainly used to examine urinary system diseases. In 1868, Desormeaux and Segelar first used the term "endoscope" in an article. Philip Bozzini's' LICHTLEITER '

　　1932年，德國人Schindler與Wolf成功研制出一種半屈式內鏡，定名為 Wolf-Schindler式胃鏡。這種內鏡由48個透鏡組成光學系統(tǒng)，燈泡光亮度強，醫(yī)生能清晰地觀察圖像。真正意義上的第一個半可屈式胃窺鏡是由 Schindler從 1928 年起與優(yōu)秀的器械制作師 Wolf 合作開始研制的 并最終在1932年獲得成功 該胃鏡直徑為12mm長為 77cm，光學系統(tǒng)由 48 個透鏡組成，前端部分可在不同水平面彎曲34°，即在胃內有一定范圍的彎曲，使術者能清晰地觀察胃粘膜圖像，該胃鏡前端有一光滑金屬球，插入較方便，燈泡光亮度較強，有空氣通道用以注氣，近端為硬管部，有接目鏡調焦。

　　In 1932, German Schindler and Wolf successfully developed a half flexion endoscope, which was named Wolf Schindler gastroscope. This endoscope consists of an optical system consisting of 48 lenses, and the light bulb has strong brightness, allowing doctors to observe images clearly. The first semi flexible gastroscope in the true sense was developed by Schindler in collaboration with the excellent instrument maker Wolf since 1928, and finally succeeded in 1932. The diameter of the gastroscope is 12mm and the length is 77cm. The optical system consists of 48 lenses, and the front end can bend 34 ° at different horizontal planes, which means there is a certain range of curvature in the stomach, allowing the surgeon to clearly observe the image of the gastric mucosa. The front end of the gastroscope has a smooth metal ball, which is easy to insert, and the light bulb has strong brightness. There is an air channel for gas injection, and the proximal end is a hard tube part with a focusing eyepiece.Wolf-Schindler 式胃鏡的創(chuàng)制，開辟了胃鏡檢查術的新紀元。

　　Schindler與Wolf的Wolf-Schindler式胃鏡

　　Schindler and Wolf's Wolf Schindler style gastroscopy

　　1960年，卡爾史托斯公司成功研發(fā)冷光源；1965年，卡爾史托斯公司研發(fā)推廣HOPKINS柱狀透鏡技術，直至今天，硬性光學鏡仍使用這一結構。

　　In 1960, Karl Storz successfully developed a cold light source; In 1965, Karl Storz developed and promoted the HOPKINS cylindrical lens technology, which is still used in rigid optical mirrors today.

　　第二階段：光纖內鏡（1957年起） 1954年，基于之前纖維傳導光源及纖維間加蓋覆層可以解決纖維間光絕緣的理論基礎，英國Hopkings及Kapany研究了纖維的精密排列，有效地解決了纖維束的圖像傳遞，為纖維光學的實用奠定了基礎。內窺鏡實現(xiàn)了一大歷史性突破，應用光纖傳像的內鏡登上舞臺。 1957年，Curtiss和Hirschowitz把大量的玻璃纖維薪合成一束，并在末端把這些纖維融合在一起，以便使它們根據(jù)自身的長度獨立活動，就此造就了第一個軟質內鏡。Hirschowitz和他的研究組制成了世界上第一個用于檢查胃、十二指腸的光導纖維內鏡原型。 1960年，美國膀胱鏡制造者公司（ACMI，現(xiàn)在年輕人應該都不知道這個品牌了，都成傳說了）向Hirschowitz提供了第一個商業(yè)纖維內窺鏡。1964年，Olympus 廠在光導纖維胃鏡基礎上，加裝了活裝置及照相機，有效地顯示了胃照相術，實時觀察胃內狀況。1966 年 Olympus 廠首創(chuàng)前端彎角機構。1967年，Machida廠采用外部冷光源，使光亮度大增，可發(fā)現(xiàn)小病灶，視野進一步擴大，可以觀察到十二指腸。隨著附屬裝置的不斷改進，如手術器械、攝影系統(tǒng)的發(fā)展，內鏡不但可用于診斷，且可用于手術治療，這意味著微創(chuàng)手術時代的到來。

　　Phase 2: Fiber Optic Endoscopy (since 1957) In 1954, based on the theoretical foundation that fiber conductive light sources and fiber to fiber cladding could solve fiber to fiber optical insulation, Hopkins and Kapany from the UK studied the precise arrangement of fibers, effectively solving the image transmission of fiber bundles and laying the foundation for the practical application of fiber optics. Endoscopy has achieved a historic breakthrough, with endoscopes utilizing fiber optic imaging taking the stage. In 1957, Curtiss and Hirschowitz combined a large amount of glass fibers into a bundle and fused these fibers together at the end to allow them to move independently according to their own length, thus creating the first soft endoscope. Hirschowitz and his research team have developed the world's first prototype of fiber optic endoscopy for examining the stomach and duodenum. In 1960, the American cystoscope manufacturer company (ACMI, now a legendary brand unknown to young people) provided Hirschowitz with the first commercial fiber endoscope. In 1964, Olympus factory added live devices and cameras on the basis of fiber optic gastroscopy, effectively displaying gastric photography and observing the condition of the stomach in real time. In 1966, Olympus factory pioneered the front-end bending mechanism. In 1967, Machida factory adopted an external cold light source, which greatly increased the brightness and allowed for the detection of small lesions, further expanding the field of view and allowing observation of the duodenum. With the continuous improvement of accessory devices such as surgical instruments and photography systems, endoscopes can not only be used for diagnosis, but also for surgical treatment, which means the arrival of the era of minimally invasive surgery.

　　Hirschowitz醫(yī)生

　　Dr. Hirschowitz

　　第三階段：CCD電子內鏡（1983年起） 1983 年美國 Welch Allyn 公司研制并應用微型圖像傳感器(charge coupled device,CCD)代替了內鏡的光導纖維導像術，宣告了電子內鏡的誕生--內鏡發(fā)展史上另一次歷史性的突破。電子內窺鏡主要由內鏡(endoscopy)、電視信息系統(tǒng)中心(video information system center)和電視監(jiān)視器(television monitor)三個主要部分組成，另外還配備一些輔助裝置，如錄像機、照相機、吸引器以及用來輸入各種信息的鍵盤和診斷治療所用的各種處置器具等。它的成像主要依賴于鏡身前端裝備的 CCD，CCD 就像一臺微型攝像機將圖像經過圖像處理器處理后，顯示在電視監(jiān)視器的屏幕上。比普通光導纖維內鏡的圖像清晰，色澤逼真，分辨率更高，而且可供多人同時觀看。由于電子內鏡的問世，給百余年來內鏡的診斷和治療開創(chuàng)了歷史新篇章，在臨床、教學和科研中發(fā)揮出它巨大的優(yōu)勢。隨后，日本的富士、奧林巴斯（1985年推出其首個電子內窺鏡系統(tǒng) EVIS-1）等企業(yè)相繼宣告電子內鏡的成功研制。從像素數(shù)量上看，光纖內鏡的分辨率一般為2萬像素，而應用CCD的電子鏡分辨率一般是光纖內鏡的20倍，這使得電子內鏡的圖像質量、細節(jié)信息、清晰程度都有了極大提升，基于內窺鏡的診療技術開啟了新的篇章。上世紀70~90年代，全球超過半數(shù)的半導體在日本生產，全球前10大半導體公司中，日本一度獨占6家，這使得日本的內鏡企業(yè)極具發(fā)展優(yōu)勢。

　　Phase Three: CCD Electronic Endoscopy (Since 1983) In 1983, Welch Allyn Company in the United States developed and applied a miniature image sensor (charge coupled device, CCD) to replace the optical fiber guidance of endoscopy, announcing the birth of electronic endoscopy - another historic breakthrough in the history of endoscopy development. Electronic endoscopes are mainly composed of three main parts: endoscopy, video information system center, and television monitor. In addition, they are equipped with auxiliary devices such as video recorders, cameras, suction devices, keyboards for inputting various information, and various treatment equipment used for diagnosis and treatment. Its imaging mainly relies on the CCD equipped at the front end of the mirror body. The CCD is like a miniature camera that processes the image through an image processor and displays it on the screen of a television monitor. Compared to ordinary fiber optic endoscopes, the image is clearer, the color is realistic, the resolution is higher, and it can be viewed by multiple people at the same time. Due to the emergence of electronic endoscopy, a new chapter in the history of endoscopic diagnosis and treatment has been opened for more than a hundred years, and it has played a huge advantage in clinical, teaching, and scientific research. Subsequently, Japanese companies such as Fuji and Olympus (which launched their first electronic endoscope system EVIS-1 in 1985) successively announced the successful development of electronic endoscopes. In terms of pixel count, the resolution of fiber optic endoscopes is generally 20000 pixels, while the resolution of electronic endoscopes using CCD is generally 20 times that of fiber optic endoscopes. This greatly improves the image quality, detail information, and clarity of electronic endoscopes, opening a new chapter in diagnosis and treatment technology based on endoscopes. In the 1970s and 1990s, more than half of the world's semiconductors were produced in Japan. Among the top 10 semiconductor companies in the world, Japan once monopolized 6, which gave Japanese endoscope companies a great development advantage.

　　CCD

　　CCD

　　第四階段：CMOS電子內鏡（1995年起）  1995年，幾位華人留學生在硅谷創(chuàng)立豪威，這家企業(yè)實現(xiàn)了此后CMOS（Complementary Metal Oxide Semiconductor，互補金屬氧化物半導體，一種集成電路的設計工藝）技術對圖像傳感器市場的破局。在當時的工藝條件下，CMOS的成像質量相較CCD稍差，但卻可以做到功耗和成本的極大降低。隨著索尼、三星等傳統(tǒng)半導體巨頭的加入和CMOS生產工藝的精進，CMOS圖像傳感器的性能逐漸提高，在內窺鏡中的應用研究也逐漸展開。與CCD相比，CMOS傳感器具有成本低、集成度高、耗電量小等優(yōu)點。 2015年5月美國豪威被由中信資本、北京清芯華創(chuàng)和金石投資組成的財團以19億美元收購，最終于2016年初完成私有化，成為北京豪威的全資子公

　　Phase Four: CMOS Electronic Endoscope (Since 1995) In 1995, several Chinese international students founded Howay in Silicon Valley, which achieved the breakthrough of CMOS (Complementary Metal Oxide Semiconductor, a design process for integrated circuits) technology in the image sensor market. Under the process conditions at that time, the imaging quality of CMOS was slightly inferior to CCD, but it could achieve significant reductions in power consumption and cost. With the addition of traditional semiconductor giants such as Sony and Samsung and the improvement of CMOS production processes, the performance of CMOS image sensors is gradually improving, and research on the application of endoscopes is also gradually unfolding. Compared with CCD, CMOS sensors have the advantages of low cost, high integration, and low power consumption. In May 2015, American Howe was acquired by a consortium consisting of CITIC Capital, Beijing Qingxin Huachuang, and Jinshi Investment for $1.9 billion. It was eventually privatized in early 2016 and became a wholly-owned subsidiary of Beijing Howe

　　CMOS

　　CMOS

　　目前，市場上的軟鏡主要使用電子鏡方案，CMOS攝像頭在鏡體前端，鏡體可彎曲，鏡體后端連接圖像處理裝置；硬鏡中電子鏡與光學鏡兩種方案并存，電子硬鏡的優(yōu)勢是不像光學鏡易損壞、不需手動調焦，而光學硬鏡的優(yōu)勢是透鏡組傳像的保真度高，CMOS安裝在鏡體后端不受鏡體直徑限制。

　　At present, the soft mirrors on the market mainly use electronic mirror solutions, with CMOS cameras at the front end of the mirror body, which can be bent, and image processing devices connected to the back end of the mirror body; There are two solutions for hard mirrors: electronic mirrors and optical mirrors. The advantage of electronic hard mirrors is that they are not as easily damaged and do not require manual focusing as optical mirrors, while the advantage of optical hard mirrors is that the lens group has high fidelity in image transmission. CMOS is installed at the rear end of the mirror body and is not limited by the diameter of the mirror body.

　　總結

　　summary

　　CCD（電荷耦合器件）和CMOS（互補金屬氧化物半導體）是兩種不同類型的圖像傳感器，它們各有特點和優(yōu)勢，以下是CCD和CMOS的主要區(qū)別及各自的優(yōu)點：CCD（Charge-Coupled Device）工作原理：CCD通過一個像素傳遞到另一個像素的方式來收集光，并將其轉換成電子信號。圖像質量：通常提供高質量的圖像，具有優(yōu)秀的光學特性和較低的噪點。靈敏度：對光線的響應較好，適合低光照條件下拍攝。能耗：相對較高，因為所有像素都是通過一個輸出節(jié)點來讀取。CMOS（Complementary Metal-Oxide-Semiconductor）工作原理：CMOS傳感器為每個像素配備了一個放大器，可以在像素處直接轉換光信號為電信號。成本和制造：制造成本較低，因為它可以使用標準的半導體制造工藝。能耗：相比CCD，CMOS的能耗較低，更適合用于便攜設備如智能手機。速度：數(shù)據(jù)讀取速度更快，適合高速攝影和視頻錄制。CCD的優(yōu)點：提供高質量的圖像，特別是在色彩重現(xiàn)、動態(tài)范圍和低光照條件下的性能方面。CMOS的優(yōu)點：成本較低，能耗低，數(shù)據(jù)處理速度快，更適合快速拍攝和長時間使用。

　　CCD (Charge Coupled Device) and CMOS (Complementary Metal Oxide Semiconductor) are two different types of image sensors, each with its own characteristics and advantages. The main differences and advantages of CCD and CMOS are as follows: CCD (Charge Coupled Device) works by collecting light from one pixel to another and converting it into electronic signals. Image quality: Typically provides high-quality images with excellent optical properties and low noise. Sensitivity: Good response to light, suitable for shooting under low light conditions. Energy consumption: relatively high because all pixels are read through one output node. The working principle of CMOS (Complementary Metal Oxide Semiconductor): CMOS sensors are equipped with an amplifier for each pixel, which can directly convert optical signals into electrical signals at the pixel. Cost and Manufacturing: The manufacturing cost is lower because it can use standard semiconductor manufacturing processes. Energy consumption: Compared to CCD, CMOS has lower energy consumption and is more suitable for portable devices such as smartphones. Speed: Faster data reading speed, suitable for high-speed photography and video recording. Advantages of CCD: Provides high-quality images, especially in terms of color reproduction, dynamic range, and performance under low light conditions. Advantages of CMOS: Low cost, low energy consumption, fast data processing speed, more suitable for fast shooting and long-term use.

　　隨著技術的發(fā)展，CMOS傳感器的性能已經大幅提升，逐漸在許多應用領域取代了CCD傳感器，特別是在消費級數(shù)碼相機和手機攝像頭中。然而，CCD仍然在一些專業(yè)和科學應用中保持著其優(yōu)勢地位。選擇哪種類型的傳感器取決于具體的應用需求、預算和期望的圖像質量。

　　With the development of technology, the performance of CMOS sensors has been greatly improved, gradually replacing CCD sensors in many application fields, especially in consumer digital cameras and mobile phone cameras. However, CCD still maintains its advantageous position in some professional and scientific applications. The choice of which type of sensor depends on specific application requirements, budget, and expected image quality.

　　顯然，一開始大家所熟知的電子內窺鏡昂貴主要是由于CCD昂貴，CCD質量越好，呈現(xiàn)畫面質量越高，價格也越高。后來CMOS出現(xiàn)了，成本比CCD還低，且于16年豪威完成私有化，大幅降低了國內企業(yè)的采購成本。這就解釋了為什么一次性內窺鏡采用的是電子芯片，而且也是近幾年一次性內窺鏡在國內蓬勃發(fā)展的主要原因。

　　Obviously, the well-known high cost of electronic endoscopes at the beginning was mainly due to the high cost of CCD. The better the quality of CCD, the higher the image quality presented, and the higher the price. Later on, CMOS emerged with lower costs than CCD, and in 2016, Huawei completed privatization, significantly reducing the procurement costs of domestic enterprises. This explains why disposable endoscopes use electronic chips, and it is also the main reason for the booming development of disposable endoscopes in China in recent years.

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