腋臭外科治疗的临床与病理观察(1)
[摘要]目的：探讨既可达到治疗彻底、疗效持久、局部美观，又无功能影响、为大家公认的腋臭外科手术术式。方法：对临床588例病例回顾总结及30例病理组织进行观察对比分析。结果：四种主要手术方法(术式)中传统的腋臭根治性切除术272例(其中一半行Z成形术)治疗彻底，只有3例(1.1%)有残留气味，但切口瘢痕长,要求修复瘢痕者有36例(包括外院手术后)。吸刮抽吸术46例中治疗不够彻底近期发现残留气味者就有5例。超声抽吸者共43例，经过病理学检查30例中有22例有顶泌汗腺残留，说明单靠超声不能达到治疗目的。腋窝皱襞横形小切口分二层修剪掏出术共227例，有3例有残留气味，但从2007年后进一步改进修剪技术后从病理学观察证实可以达到无顶泌汗腺残留。结论：改良后的腋窝皱襞1～2个横切口(2.5～3cm),翻转皮瓣分二层剥离修剪(简称小切口分层修剪术)可以达到清除大小汗腺，使治疗彻底、并发症少、疗效持久、外形美观、无功能影响的效果。
[关键词]腋臭；顶泌汗腺；切除术；修剪术
, http://www.100md.com [中图分类号]R622[文献标识码]A[文章编号]1008-6455(2008)10-1421-04
Clinical and pathological Investigation about the surgical treatment of axillary osmidrosis
LU Kai-hua1,PENG Pai1,LIU Bin1,PAN Yong1,LIAO Wen-jun2,GUO Shu-zhong1,LIU Dan1
(1. Institute of Plastic Surgery,2. Department of Dermatology Xijing Hospital,Fourth Military Medical University,Xi'an 710032,Shaanxi,China)
Abstract： ObjectiveTo find a surgical technique to treat axillary osmidrosis which has good cosmetic and functional results with the thorough and permanent therapeutic effect.MethodsRetrospective study and 588 clinical cases and 30 pathological cases comparative analysis.ResultsFour different surgical techniques were used for the treatment of Axillary Osmidrosis. 272 cases were treated by traditional radical cure excision and 'Z' plasty was used for half of them. More than 36 cases (including the cases treated by other hospitals) complained about the incisional scar during the next four years although only 3 cases have residual odour. 46 cases were treated by scraping and sucking method. 5 cases were found to have resicual odour during a short time after-operation. 43 cases were treated by ultrasound sucking method. 22/30 cases have residual apocrine sweat gland by the pathological examination which suggest ultrasound effect is limited to reach the clinical requirement. 227 cases were treated by axillary laterigrade incision double layer trimming method. 3 cases have residual odour. After 2007, a new modified double layer trimming method were used to treat axillary osmidrosis and confirmed no residual apocrine sweat gland by the pathological examination.ConclusionsThe new modified double layer trimming method with one or two axillary laterigrade incision (2.5～3cm) is a good chose to treat axillary osmidrosis, which can clear up apocrine sweat gland and hair sebaceous follicle with less complication, more permanent clinical result, better cosmetic and functional effect.
, 百拇医药
Key words: axillary osmidrosis; apocrine sweat gland; excision; trimming
腋臭是临床上的常见病，随着人民生活水平的提高，要求治疗者日益增多。腋臭的治疗方法与术式繁多，国内外文献很多[1-4]，说明至今仍未找到一种疗效持久、痛苦小、并发症少，既达到治疗彻底、局部美观、无功能障碍、又为大家公认的方法。为此作者对常用的几种手术方法(术式)作了临床与病理学的观察，现报道如下。
1临床资料
2004年～2008年6月，我科门诊手术的腋臭病人共635例，除再次治疗与瘢痕修整者47例外，初期治疗共588例，年龄10～50岁，以18～30岁者居多(占80%以上)。女性较多，男女比为22:78。手术治疗方法：在2006年以前以传统的腋臭切除术为主，棱形的长切口，为了防止瘢痕挛缩，有一半病例在缝合前作Z成形术。以后曾试探过小切口掏除术、吸刮抽吸术、皮瓣翻转修剪术，以后又试行超声去脂去大汗腺的方法，通过临床及病理学观察，本文将根据这些探索，提出一种比较理想的手术方法。
1.1 腋臭根治切除术：传统的比较有效的方法是将腋窝区有腋毛的皮肤连同皮下脂肪组织棱形完整的切除，深达筋膜层上，因而手术能较彻底的去除大汗腺(又称顶泌汗腺或称顶浆汗腺)术后复发率低，但因术后留下较长的切口瘢痕，有时被拉得很宽或不规整，甚至影响肩关节功能，即便如此，仍有部分病例还有腋臭残留，主要是在腋毛外0.5～1.0cm的范围内可能仍有大汗腺未切除所致。为减少瘢痕挛缩，曾在棱形切除后在中线部位形成二个Z形皮瓣，换位缝合可以缓解瘢痕增生及挛缩。, 百拇医药(鲁开化 彭 湃 刘 斌 潘 勇 廖文俊 郭树忠 刘 丹)
[关键词]腋臭；顶泌汗腺；切除术；修剪术
, http://www.100md.com [中图分类号]R622[文献标识码]A[文章编号]1008-6455(2008)10-1421-04
Clinical and pathological Investigation about the surgical treatment of axillary osmidrosis
LU Kai-hua1,PENG Pai1,LIU Bin1,PAN Yong1,LIAO Wen-jun2,GUO Shu-zhong1,LIU Dan1
(1. Institute of Plastic Surgery,2. Department of Dermatology Xijing Hospital,Fourth Military Medical University,Xi'an 710032,Shaanxi,China)
Abstract： ObjectiveTo find a surgical technique to treat axillary osmidrosis which has good cosmetic and functional results with the thorough and permanent therapeutic effect.MethodsRetrospective study and 588 clinical cases and 30 pathological cases comparative analysis.ResultsFour different surgical techniques were used for the treatment of Axillary Osmidrosis. 272 cases were treated by traditional radical cure excision and 'Z' plasty was used for half of them. More than 36 cases (including the cases treated by other hospitals) complained about the incisional scar during the next four years although only 3 cases have residual odour. 46 cases were treated by scraping and sucking method. 5 cases were found to have resicual odour during a short time after-operation. 43 cases were treated by ultrasound sucking method. 22/30 cases have residual apocrine sweat gland by the pathological examination which suggest ultrasound effect is limited to reach the clinical requirement. 227 cases were treated by axillary laterigrade incision double layer trimming method. 3 cases have residual odour. After 2007, a new modified double layer trimming method were used to treat axillary osmidrosis and confirmed no residual apocrine sweat gland by the pathological examination.ConclusionsThe new modified double layer trimming method with one or two axillary laterigrade incision (2.5～3cm) is a good chose to treat axillary osmidrosis, which can clear up apocrine sweat gland and hair sebaceous follicle with less complication, more permanent clinical result, better cosmetic and functional effect.
, 百拇医药
Key words: axillary osmidrosis; apocrine sweat gland; excision; trimming
腋臭是临床上的常见病，随着人民生活水平的提高，要求治疗者日益增多。腋臭的治疗方法与术式繁多，国内外文献很多[1-4]，说明至今仍未找到一种疗效持久、痛苦小、并发症少，既达到治疗彻底、局部美观、无功能障碍、又为大家公认的方法。为此作者对常用的几种手术方法(术式)作了临床与病理学的观察，现报道如下。
1临床资料
2004年～2008年6月，我科门诊手术的腋臭病人共635例，除再次治疗与瘢痕修整者47例外，初期治疗共588例，年龄10～50岁，以18～30岁者居多(占80%以上)。女性较多，男女比为22:78。手术治疗方法：在2006年以前以传统的腋臭切除术为主，棱形的长切口，为了防止瘢痕挛缩，有一半病例在缝合前作Z成形术。以后曾试探过小切口掏除术、吸刮抽吸术、皮瓣翻转修剪术，以后又试行超声去脂去大汗腺的方法，通过临床及病理学观察，本文将根据这些探索，提出一种比较理想的手术方法。
1.1 腋臭根治切除术：传统的比较有效的方法是将腋窝区有腋毛的皮肤连同皮下脂肪组织棱形完整的切除，深达筋膜层上，因而手术能较彻底的去除大汗腺(又称顶泌汗腺或称顶浆汗腺)术后复发率低，但因术后留下较长的切口瘢痕，有时被拉得很宽或不规整，甚至影响肩关节功能，即便如此，仍有部分病例还有腋臭残留，主要是在腋毛外0.5～1.0cm的范围内可能仍有大汗腺未切除所致。为减少瘢痕挛缩，曾在棱形切除后在中线部位形成二个Z形皮瓣，换位缝合可以缓解瘢痕增生及挛缩。, 百拇医药(鲁开化 彭 湃 刘 斌 潘 勇 廖文俊 郭树忠 刘 丹)