肋间臂神经切断术治疗腋臭的解剖学基础及临床应用可行性探讨

A feasibility study to a new therapeutics to bromhidrosis:the resection of intercostobrachial nerves

目的探讨肋间臂神经(Intercostobrachialnerves,ICBN)切除治疗腋臭的可行性,并提供相关解剖学基础。方法对25具成人尸体的50侧腋区进行解剖,观测腋窝被毛区的神经支配情况;另对合并腋臭的20例乳癌患者分两组进行切除或保留ICBN的手术,观察切除ICBN对腋臭的影响。结果 ICBN可分为缺如型(4%)、单干型(10%)、单干分支型(50%)、双干型(28%)及3干型(8%);95.83%的ICBN均参与腋窝被毛区的支配,其中,单干型全部分支进入腋窝被毛区,单干分支型及多干型者则由下支或下干支配腋窝被毛区,其上支、上干单独或与臂内侧皮神经汇合进入上臂内侧;34%的第3肋间神经外侧皮支可发支达腋窝被毛区。乳癌根治术中切除ICBN可消除腋臭,保留ICBN者腋臭无变化。结论切除ICBN或其上支、上干,从而消除腋窝被毛区汗腺的分泌以治疗腋臭是可行的。

Objective To explore the feasibility of a new therapeutics to bromhidrosis： the resection of intercostobrachial nerves（ICBN）,and to provide associated anatomic basis.Methods Axillary region dissection was performed on 25 adult embalmed cadavers（50 sides）,including the observation of the innervations of axillary hairs regional skin.In addition,20 breast cancer patients with bromhidrosis underwent mastectomy removing or retaining ICBN for further exploring the effect of ICBN resection on bromhidrosis.Results ICBN can be divided into five types,including vacancy type（4%）,single trunk type（10%）,single trunk with branches type（50%）,two trunks type（28%） and three trunks type（8%）.For 95.83% specimens,ICBN dominated the axillary hairs region.Among the total,single trunk type ICBN dominated axillary hairs region completely,however,only inferior trunks or branches of the other types ICBN dominated the same region,meanwhile,the upper trunks or branches entered the inner part of upper arm singly or joined with medial brachial cutaneous nerve.34% of lateral cutaneous branch of the third intercostal nerve dominated a part of axillary hairs region.Resecting of ICBN can eliminated bromhidrosis,retaining of ICBN has no effect on brohidrosis.Conclusions Resecting ICBN or it＇s inferior trunks or branches will terminate secretion of sweat glands in axillary hairs regional skin,it can be used as a new method to treat bromhidrosis.