Mátrai Zoltán, Gulyás Gusztáv, Kunos Csaba, Sávolt Akos, Farkas Emil, Szollár András, Kásler Miklós
Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122.
Orv Hetil. 2014 Feb 1;155(5):162-9. doi: 10.1556/OH.2014.29783.
Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices - similar to other surgical subspecialties -, will gradually become popular and it may form part of routine breast surgery even. Vacuum-assisted core biopsy with a therapeutic indication is suitable for the removal of benign fibroadenomas leaving behind an almost invisible scar, while endoscopically assisted skin-sparing and nipple-sparing mastectomy, axillary staging and reconstruction with latissimus dorsi muscle flap are all feasible through the same short axillary incision. Endoscopic techniques are also suitable for the diagnostics and treatment of intracapsular complications of implant-based breast reconstructions (intracapsular fluid, implant rupture, capsular contracture) and for the biopsy of intracapsular lesions with uncertain pathology. Perception of the role of radiofrequency ablation of breast tumors requires further hands-on experience, but it is likely that it can serve as a replacement of surgical removal in a portion of primary tumors in the future due to the development in functional imaging and anticancer drugs. With the reduction of the price of ductoscopes routine examination of the ductal branch system, guided microdochectomy and targeted surgical removal of terminal ducto-lobular units or a "sick lobe" as an anatomical unit may become feasible. The paper presents the experience of the authors and provides a literature review, for the first time in Hungarian language on the subject. Orv. Hetil., 2014, 155(5), 162-169.
由于医学科学和工业技术的发展，微创技术已出现在良性和恶性乳腺疾病的手术中。一般来说，此类干预措施可显著减少乳房和胸壁瘢痕，缩短住院时间并减轻疼痛，但它们需要特定的、昂贵的设备，与开放手术相比手术时间更长。此外，其适应症或肿瘤学安全性尚未确立。很有可能，使用高科技设备的微创手术——与其他外科亚专业类似——将逐渐普及，甚至可能成为常规乳腺手术的一部分。具有治疗指征的真空辅助核心活检适用于切除良性纤维腺瘤，术后留下几乎不可见的瘢痕，而内镜辅助的保乳和乳头保留乳房切除术、腋窝分期以及背阔肌皮瓣重建均可行通过相同的短腋窝切口完成。内镜技术还适用于基于植入物的乳房重建的囊内并发症（囊内积液、植入物破裂、包膜挛缩）的诊断和治疗，以及对病理不确定的囊内病变进行活检。对乳腺肿瘤射频消融作用的认识需要更多实际经验，但由于功能成像和抗癌药物的发展，未来它有可能在一部分原发性肿瘤中替代手术切除。随着导管镜价格的降低，对导管分支系统进行常规检查、引导性微导管切除术以及作为解剖单位的终末导管小叶单位或“患病小叶”的靶向手术切除可能变得可行。本文首次以匈牙利语介绍了作者的经验并提供了文献综述。《匈牙利医学周报》，2014年，第155卷，第5期，第162 - 169页。
