Mátrai Zoltán, Kunos Csaba, Pukancsik Dávid, Sávolt Akos, Gulyás Gusztáv, Kásler Miklós
Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth Gy. u. 7-9. 1122.
Orv Hetil. 2014 Jan 19;155(3):106-13. doi: 10.1556/OH.2014.29782.
Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible. During these complex interventions, the latissimus dorsi flap formed by endoscopic technique (leaving no scar on the back), rotated to the anterior chest wall can be used for total autologous reconstruction of low-volume breasts as complete coverage of implants placed under the spared skin-envelope or for revitalization of thin or radiation damaged breast skin. This paper presents 4 cases of breast reconstruction with endoscopically assisted latissimus dorsi muscle flap, and the authors demonstrate the surgical technique in detail and conduct a literature review, for the first time in Hungarian.
保乳及乳头的乳房切除术在乳腺癌手术的系统层面上使即刻乳房重建成为可能。女性最常见恶性肿瘤所带来的大规模重建需求只能通过使用基于植入物的技术来满足，这些技术能提供出色的美容效果并使患者满意度很高。对于这些乳房切除术后的重建，皮肤的替代已不再是挑战，而是植入物的良好血管化、高质量软组织覆盖。如今的肿瘤整形乳房手术能够通过在腋窝处做6 - 10厘米的切口，在肿瘤学上彻底完全切除腺体组织，几乎无痕地保留乳房的天然皮肤包膜，同时进行充分的腋窝分期（前哨淋巴结活检/腋窝淋巴结清扫术），然后利用同一切口，实施一步或多步乳房重建。在这些复杂的手术中，通过内镜技术形成（背部不留疤痕）并旋转至前胸壁的背阔肌肌皮瓣可用于小容量乳房的全自体重建，作为对置于保留皮肤包膜下的植入物的完全覆盖，或用于修复变薄或受放疗损伤的乳房皮肤。本文介绍了4例应用内镜辅助背阔肌肌皮瓣进行乳房重建的病例，作者首次在匈牙利语中详细展示了手术技术并进行了文献综述。
