目的回顾总结完全胸腔镜下微创手术治疗先天性心脏病90例的临床经验。方法通过右侧胸壁胸骨旁第三肋间，腋中线第四肋间，腋前线第五肋间三个1～2 cm孔状切口，经股动静脉插管建立体外循环，在胸腔镜下显露术野并实施手术。结果90例均治愈出院，无肾功能衰竭、呼吸衰竭、低心排血量、房室传导阻滞及残余分流等严重并发症，62例（68.9％）完全无血制品输注，红细胞输注量为0～4 U，中位数0（2）U；血浆输注量为0～600 ml，中位数0（0）ml。术后随访1～3个月，患者1～4周恢复正常工作学习，中位数2（1）周。结论全胸腔镜下心脏手术具有创伤小、出血少、恢复快、瘢痕小、切口相对隐蔽、符合美观要求等优点。右胸“三孔法”入路对房间隔缺损、膜周部室间隔缺损、二尖瓣、三尖瓣均有很好的显露，术野清晰，并可兼顾主动脉根部操作，对于房间隔缺损修补、室间隔缺损修补、三尖瓣成形、部分型房室间隔缺损矫治等常见先天性心脏病直视手术操作可行，效果良好。%Objective To review the experiences of totally thoracoscopic minimally invasive cardiac surgery for 90 cases of congenital heart disease .Methods Through three hole shape incision at the right chest wall,that each was 1 to 2 cm long,operation field were revealed totally by thoracoscope .Extracorporeal circulation was built through femoral arteriovenous intubation .Results 90 patients were all cured .None of them suffered severe complications such as renal failure , respiratory failure , low cardiac output syndrome , atrioventricular block and residual shunt .Red blood cell transfusion volume was 0-4 U.The median was 0 U and the interquartile range was 2 U.Plasma infusion quantity was 0-600 ml.The median was 0 ml and the interquartile range was 0 ml.62 patients ( 68.9%) avoided any blood products transfusion completely .Postoperative follow-up for one to three months,most patients spent one to four weeks to restore normal life .The median was 2 weeks and the interquartile range was 1 week .Conclusions Totally thoracoscopic minimally invasive cardiac surgery provided small trauma , less bleeding ,faster recovery and little scar ,relatively hidden incision .The three hole incisions method of right chest wall provided clear operation field for repairing atrial septal defect , ventricular septal defect , tricuspid valve and partial endocardial cushion defect .The operation was feasible and the results were good .
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