自体脂肪基质血管成分移植辅助小切口皮瓣手术汗腺切除治疗腋臭临床观察

Clinical observation of autologous adipose-derived stromal vascular fraction transplantation-assisted small incision skin flap surgery for sweat gland resection in treatment of axillary osmidrosis

目的观察自体脂肪基质血管成分(SVF)移植辅助小切口皮瓣手术汗腺切除治疗腋臭的临床效果。方法 将28例腋臭患者的左右腋窝术区随机分为实验组和对照组,均接受小切口皮瓣手术汗腺切除治疗。小切口皮瓣手术汗腺切除的同时,抽取患者腹部脂肪,分离、提取自体脂肪SVF,待小切口皮瓣手术切口缝合后,实验组于皮瓣与掀起皮瓣的脂肪浅层之间注射自体脂肪SVF,对照组同位置注射等量生理盐水。术后半个月时计算两组术区切口Ⅰ期愈合率;术后第1、3、6、12个月随访时,使用多探头皮肤测试系统检测两组术区皮肤和术区周围正常皮肤的颜色、含水量、摩擦力及温度,计算术区各个测量值与周围正常皮肤测量值的比值;术后第1、12个月随访时调查患者满意度,计算总满意率。结果 术后半个月时,实验组Ⅰ期愈合率为92.9%,对照组为71.4%,两组相比,P<0.05。实验组皮肤颜色在随访第6、12个月时较对照组显著改善(P均<0.05),皮肤含水量在随访第3、6、12个月时较对照组升高(P均<0.05),皮肤摩擦力在随访第3、6、12个月时较对照组显著改善(P均<0.05)。术后第1个月实验组总满意率82.1%,对照组总满意率75%,两组相比,P>0.05;术后第12个月实验组总满意率96.4%,对照组总满意率71.4%,两组相比,P<0.05。结论 自体脂肪SVF移植辅助小切口皮瓣手术汗腺切除治疗腋臭可以有效改善切口愈合和皮肤质地,患者远期满意度得到有效提高。

Objective To investigate the clinical effect of stromal vascular fraction (SVF) transplantation in improving the small incision skin flap method of the sweat gland removal for the radical treatment of axillary osmidrosis. Methods The left and right axillary areas of 28 patients with osmidrosis were randomly divided into the experimental group and control group, all of which were treated with small incision skin flap for sweat gland resection. At the same time of sweat gland resection with small incision skin flap, abdominal fat of the patients was extracted to separate and extract SVF. After incision suture in small incision skin flap surgery, the experimental group was injected with SVF between the skin flap and the superficial fat layer of the flap, while the control group was injected with the same amount of normal saline in the same position. The wound healing rate at stage I was observed half a month after surgery. The changes of pigment, moisture content, friction force and temperature in the operation area were detected by Multi Probe Adapter 10 at the 1st, 3rd, 6th and 12th months. The ratio of the measurements in the operative area to the measurements in the surrounding normal skin was calculated. The patients' satisfaction was investigated and the total satisfaction rate was calculated at the first and 12th months of follow-up. Results After half a month, the wound healing rates at stage I of the experimental group and control group were 92.9% and 71.4%, respectively, with statistically significant difference ( P <0.05). Skin color in the experimental group was significantly improved as compared with that in the control group at the 6th and 12th months of follow-up (both P <0.05). The skin moisture content increased as compared with that of the control group at the 3rd, 6th and 12th months of follow-up (all P <0.05). Compared with the control group, skin friction was significantly improved at the 3rd, 6th and 12th months of follow-up (all P <0.05). In the first month after surgery, the total satisfaction rates of the experimental group and control group were 82.1% and 75%, respectively, with no statistically significant difference ( P > 0.05 ). The total satisfaction rates was 96.4% in the experimental group, versus 71.4% in the control group at the 12th month after surgery, with statistically significant difference ( P <0.05). Conclusion Autologous adipose-derived SVF transplantation-assisted small incision skin flap surgery for sweat gland resection in treatment of axillary osmidrosis can effectively improve the wound healing and skin texture, and patients' long-term satisfaction.