直视下皮瓣修剪术治疗腋臭远期的组织学观察与手术要点

Long term histological studies and surgical key points of subcutaneous pruning method for treatment of axillary osmidrosis under direct vision

目的对接受直视下皮瓣修剪术治疗腋臭患者的手术效果及术后远期组织病理学进行观察，探讨该术式的手术要点。方法自2008年1月至2011年1月，我们采用直视下皮瓣修剪术治疗腋臭患者68例，随访6～12个月，对其中10例重度腋臭患者进行了术中和术后1年的组织病理学观察。结果本组68例患者治愈66例，治愈率达97．1％；显效2例，占2．9％。10例重度腋臭患者行组织病理学检查的结果：术中皮瓣修剪前观察到皮瓣上有大量顶泌汗腺；皮瓣修剪后未观察到顶泌汗腺；术后1年观察到皮下脂肪层有少量顶泌汗腺残留。结论直视下皮瓣修剪术治疗腋臭可将大量顶泌汗腺直接清除，残留的顶泌汗腺导管部亦被剪断破坏，从而使腋臭治愈；显效病例系术中皮瓣分离范围不够或皮瓣修剪不到位所致。术中重视手术要点的处理，可达到治愈率高、并发症低的满意效果。

Objective To explore the surgical key points of subcutaneous pruning method for treatment of axillary osmidrosis under direct vision by observing surgical effect and long term histological representation. Methods A total of 68 cases of osmidrosis were treated by subcutaneous pruning method under direct vision form January 2008 to January 2011, who were followed up for 6 to 12 months. Ten patients with severe axillary osmidrosis were observed by histological examination before operation and at 1 year after operation. Results Patho- logical results confirmed that there were a large amount of apocrine sweat glands under axillary skin before pruning and no that was found after operation. Meanwhile there were a small amount of residual apocrine sweat glands in adipose layer one year after operation. Clinical results showed that for those 68 patients, the cure rate was 97.1% （66 cases） and efficiency rate was 2.9% （2 cases）. All those 10 patients with severe axillary osmidrosis who were given histological examination were clinically cured. Conclusion The subcutaneous pruning method for treatment of axillary osmidrosis under direct vision can clean up apocrine sweat glands and cut the duct of residual apocrine sweat glands and thus cure osmidrosis. The reasons for those effective cases were insufficient range and imperfect performance of subcutaneous pruning. Pay more attention to those key points that mentioned in the text may increase the cure rate and decrease the complications.