CAJ | 학술논문

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。
목적회고총결완전흉강경하미창수술치료선천성심장병90례적림상경험。방법통과우측흉벽흉골방제삼륵간，액중선제사륵간，액전선제오륵간삼개1～2 cm공상절구，경고동정맥삽관건입체외순배，재흉강경하현로술야병실시수술。결과90례균치유출원，무신공능쇠갈、호흡쇠갈、저심배혈량、방실전도조체급잔여분류등엄중병발증，62례（68.9％）완전무혈제품수주，홍세포수주량위0～4 U，중위수0（2）U；혈장수주량위0～600 ml，중위수0（0）ml。술후수방1～3개월，환자1～4주회복정상공작학습，중위수2（1）주。결론전흉강경하심장수술구유창상소、출혈소、회복쾌、반흔소、절구상대은폐、부합미관요구등우점。우흉“삼공법”입로대방간격결손、막주부실간격결손、이첨판、삼첨판균유흔호적현로，술야청석，병가겸고주동맥근부조작，대우방간격결손수보、실간격결손수보、삼첨판성형、부분형방실간격결손교치등상견선천성심장병직시수술조작가행，효과량호。
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 .