应用水刀“5Ms”原则及“W-O”法治疗腋臭的临床效果研究

The application of hydrosurgery with the "5Ms" and "W-O" method in the treatment of osmidrosis

目的 评估运用“5Ms”原则及“W-O”法的水刀微创术式以及传统平行双切口术式治疗腋臭的临床效果。方法 自2016年1月至2019年12月,海军军医大学附属长海医院整形外科分别采用平行双切口的传统术式(传统术式组)和应用水刀“5Ms”原则及“W-O”法的水刀手术(水刀组)治疗76例腋臭患者,其中水刀组40例,传统术式组36例。传统术式组横向行2个3.0 cm长的平行切口,水刀组遵循“5Ms”原则和“W-O”法。“5Ms”原则是指<1 cm切口(毫米级切口),切口位于长轴的中间位置(middle),使用中等功率设置(medium power grade),运用中等速度(medium speed, 1 cm/s),多次往复(multiple times)清除皮下组织和汗腺。“W-O”法是指水刀去除皮下组织和汗腺时呈中间往复及周边环形的路径方式。手术过程为标记腋毛范围后,局部麻醉下行8~10 mm切口,水刀伸入切口中,运动轨迹以“W-O”法往复运动,切除大汗腺,缝合伤切口。所有患者均进行八字绷带加压包扎,术后1周拆除绷带并拆线。所有患者获随访12~24个月,采用视觉模拟评分法进行疗效评价。结果 水刀组平均手术时间为27.5 min,传统术式组为54.4 min,差异具有统计学意义(P<0.05)。传统术式组瘢痕形成及挛缩和切口边缘坏死的发生率高于水刀组(P<0.05),其他并发症发生率差异无统计学意义(P>0.05)。水刀组患者满意度优于传统术式组(P<0.05);两组异味减少度和腋毛减少度差异无统计学意义(P>0.05)。两组患者随访期间均无复发。结论 应用水刀“5Ms”原则及“W-O”法治疗腋臭手术效果良好、并发症较少,患者满意度较高,是一种简单、微创、安全、有效的治疗方法,值得临床推广。

Objective To evaluate the clinical effect of the traditional two-parallel incision surgery and hydrosurgery with the "5Ms" and "W-O" method in the treatment of osmidrosis. Methods Seventy-six patients bothered by axillary osmidrosis were treated with hydrosurgery(40 patients) and traditional surgery(36 patients) between January 2016 and December 2019. The traditional surgical method is to make two parallel incisions of 3.0 cm in length, and the hydrosurgery follows the "5Ms" and "W-O" method. The "5Ms" principle refers to an incision of less than 1 cm(mm incision), located in the middle of the long axis(middle), using a medium power setting(medium power grade), using a medium speed(medium speed, 1 cm/s), and multiple times to remove subcutaneous tissue and sweat glands. The handpiece was turned upside down to shave the subcutaneous tissue and sweat gland in a "W-O" way, that is the Versajet was moved in the undermining area in a W-shaped route and an O-shaped route for the margin of the operational area. After marking the range of axillary hair, an 8 to 10 mm incision was made under local anesthesia, the Versajet was extended into the incision, the movement track was reciprocated with "W-O type", apocrine glands were removed, and the wound was sutured. All patients underwent compression bandage with figure-eight bandages, and the bandages and sutures were removed 1 week after surgery. The curative effect was observed after the operation, and all patients were followed up for 12 to 24 months, and the curative effect was evaluated by visual analog score. Results The mean operative time was 27.5 minutes in the hydrosurgery group and 54.4 minutes in the traditional surgery group, with a statistically significant difference(P<0.05). The incidence rate of scar formation and contracture and incision margin necrosis was higher in the traditional surgery group than that in the hydrosurgery group(P<0.05), while the incidence of other complications did not differ statistically(P>0.05). Postoperative patient satisfaction was better in the hydrosurgery group than that in the traditional surgery group(P<0.05), whereas the differences in odour reduction and axillary hair reduction between the two groups were not statistically significant(P>0.05). There were no recurrences during the follow-up period in either group. Conclusion The application of hydrosurgery with the "5Ms" and "W-O" method in the treatment of osmidrosis has the advantages of good effect, fewer complications, and high satisfaction. Moreover, it is a simple,minimally invasive, efficient, safe, and effective method, which is worth popularizing.