比较全胸腔镜下和传统胸正中切口行二尖瓣置换、三尖瓣环形成术的临床效果。

选择2017年1月至2018年12月于海口市人民医院(中南大学湘雅医学院附属海口医院)和暨南大学附属第一医院就诊的患者60例，按照患者意愿选择手术方式，全胸腔镜下手术为试验组31例，传统胸正中切口手术为对照组29例。试验组做全胸腔镜下二尖瓣置换、三尖瓣环形成术，对照组做传统胸正中切口二尖瓣置换、三尖瓣环形成术。记录两组患者的手术时间、升主动脉阻断时间、心肺转流时间、切口范围、术后机械呼吸时间、监护室停留时间、术后住院时间、胸液引流量和引流管拔除时间，并观察患者术后并发症的发生情况。

试验组的手术时间、心肺转流时间、切口范围、关胸时间均小于对照组(P<0.05)，而升主动脉阻断时间差异无统计学意义(P>0.05)。试验组术后机械呼吸时间、监护室停留时间、术后住院时间、胸液引流量和引流管拔除时间均小于对照组(P<0.05)。试验组气胸发生1例，肺部感染发生2例，心律失常发生1例，总不良反应发生率为6.56%，对照组气胸发生2例，肺部感染发生4例，心律失常发生3例，总不良反应发生率为14.52%(P<0.05)。

全胸腔镜下二尖瓣置换、三尖瓣环形成术的手术时间、心肺转流时间、关胸时间、术后机械呼吸时间、监护室停留时间、术后住院时间、引流管拔除时间更短，手术切口更小，术后引流物少，并且并发症少，安全性和实用性较高。

To compare the clinical effects of mitral valve replacement and tricuspid annuloplasty under a total thoracoscope and with traditional median thoracic incision.

According to the inclusion and exclusion criteria, 60 patients who visited Haikou People′s Hospital (Affiliated to Xiangya Medical College of Zhongnan University) and the First Affiliated Hospital of Jinan University in Guangzhou from January 2017 to December 2018 were selected for this study. According to the patients′wishes, 31 cases underwent total thoracoscopic mitral valve replacement and tricuspid annuloplasty as the experimental group and 29 cases underwent mitral valve replacement and tricuspid annuloplasty with traditional median thoracic incision as the control group. The operation time, ascending aorta blocking time, cardiopulmonary bypass time, incision range, duration of postoperative mechanical ventilation, residence time in the intensive care unit, hospital stay time after operation, thoracic fluid drainage and drainage tube extraction time were recorded, and the occurrence of postoperative complications was observed.

The operation time, cardiopulmonary bypass time, incision range and chest closure time in the experimental group were less than those of the control group (P<0.05), while the ascending aorta occlusion time had no statistical significance between the two groups (P>0.05). The duration of mechanical ventilation, the residence time in the intensive care unit, the hospital stay time, the drainage volume of pleural fluid and the time of drainage tube removal in the experimental group were all less than those of the control group (P<0.05). In the experimental group, pneumothorax was found in 1 case, pulmonary infection in 2 cases and arrhythmia in 1 case, with the total incidence of adverse reactions of 6.56%. While in the control group, pneumothorax was found in 2 cases, pulmonary infection in 4 cases and arrhythmia in 3 cases, with the total incidence of adverse reactions of 14.52% (P<0.05).

Compared with the traditional median thoracic incision, the mitral valve replacement and tricuspid annuloplasty under a total thoracoscope has shorter operation time, cardiopulmonary bypass time, chest closure time, mechanical breathing time after operation, residence time in the intensive care unit, hospitalization time after operation and drainage tube extraction time, smaller incision, fewer drainage materials after operation, and fewer complications. Therefore, it has more safety and higher practicability.