顺腋纹小切口腋臭根治术并发症的处理和分析(1)
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[摘要]目的:探讨顺腋纹小切口腋臭根治术后并发症出现的原因和处理方法。方法:回顾187例顺腋纹小切口腋臭根治术的病例资料,统计术后发生并发症的情况,分析其出现的原因,阐述防治措施。结果:187例患者中有26例发生术后并发症,其中血肿6例(3.21%),切缘愈合不良10例(5.35%),皮肤坏死2例(1.07%),异味残留8例(4.28%)。结论:顺腋纹小切口腋臭根治术具有创伤小、切口隐蔽、外形美观、无功能障碍的优点,术中操作规范,采取相应的措施可以减少并发症的发生。
[关键词]小切口;腋臭;并发症
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2010)09-1277-03
Analysis and treatment about postoperative complications on radical operation of axillary osmidrosis by a micro-incision along central crease of axillary
ZHANG Nan,XIAO Chang-ming,SUN Peng,LI Hong-zhang,YANG Kun
(Department of Burns and Plastic Surgery,the First People's Hospital of Neijiang,Neijiang 641000,Sichuan,China)
Abstract:0bjectiveTo investigate the causes and the treatment strategies of postoperative complications on radical operation of axillary osmidrosis by a micro-incision along central crease of axillary.MethodsRetrospecting 187 clinic cases which accepted radical treatment of axillary osmidrosis by a small incision along central crease of axillary,analyzing the causes of postoperative complications and elaborating the means of prevention and treatment.ResultsAmong the 187 cases,26 cases had postoperative complications,including 6 cases of haematoma(3.21%),10 cases of the edge of cut healed badly(5.35%),2 cases of necrosis(1.07%)and 8 cases of relieved(4.28%).ConclusionsThe surgical technique has the merits of slight wound,inconspicuous incision,fine appearance and without dysfunction,postoperative complications could be decreased by standardizing the operations and adopting corresponding measures.
Key words: micro-incision; axillary osmidrosis; complications
腋臭的主要症状是腋窝散发出恶臭难闻的气味,严重影响患者社会交往和生活,造成心理压力,甚至导致患者心理障碍。顺腋纹小切口腋臭根治术(又名小切口翻转大汗腺毛囊剪除皮肤原位回植术)是目前既有效,又美观、无功能障碍的治疗方法。我院烧伤整形科对187例腋臭患者实施顺腋纹小切口腋臭根治术,疗效肯定,术后有少部分患者出现了并发症,笔者对所发生的并发症原因及处理方法进行分析总结,以期供同行参考,减少并发症的发生。
1资料和方法
1.1 临床资料:2006年2月～2009年12月,门诊腋臭患者187例,男性45例,女性142例,年龄18～42周岁,平均年龄25.9岁,均为双侧腋臭,其中院外行皮下搔刮术后残留异味4例,经微波治疗后复发3例,CO2激光治疗后无效1例,其余为首次治疗。所有患者既往无严重疾病,术前行血常规和出凝血时间检查无异常,女性患者避开月经期。
1.2 手术方法:患者仰卧位,屈肘外展双手置于头顶,刮除腋毛,在腋毛区域外0.5～1cm标记皮下剥离范围,于剥离范围中央标记顺腋纹切口线,长度略短于腋毛区短径,对腋毛范围宽广者,采用平行的双切口,中间距离为2.5～3cm[1]。术区用含肾上腺素局麻药行局部浸润肿胀麻醉后,切开皮肤,尖刀片在皮下浅层锐性分离至标记线。翻转皮肤,直视下用眼科剪紧贴真皮彻底剪除真皮下的粟粒状小汗腺、皮脂腺、毛囊、大汗腺和少量的皮下脂肪,真皮下血管周围大汗腺最多,术中不予保留,实际修剪范围达腋毛平面外无大汗腺分布而呈发亮的黄色纯脂肪区[2] ......
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