腋臭外科治疗的临床与病理观察

Clinical and pathological Investigation about the surgical treatment of axillary osmidrosis

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。

Objective To find a surgical technique to treat axillary osmidrosis which has good cosmetic and functional results with the thorough and permanent therapeutic effect. Methods Retrospective study and 588 clinical cases and 30 pathological cases comparative analysis. Results Four 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. Conclusions The 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.