汗腺疾病

20141443腋臭患者腋区顶泌汗腺的分布特点/邢卫斌（河北沧州市医院皮肤科）,刘文芳,赵子申…//中华皮肤科杂志.-2014,47（3）.-203～205 对2010年9-12月间的15例腋臭患者行直视下顶泌汗腺剪除术,切取切口处宽约2mm的全层皮肤,深度达腋浅筋膜浅层,用于判明顶泌汗腺分布的深度。留取腋中心（点1）、距腋中心1cm（点2）、距腋毛边缘内1cm（点3）、腋毛边缘（点4）、距腋毛边缘外1cm（点5）共5个标记点对应的皮下暗红色粗大的颗粒状组织，用于判明顶泌汗腺的分布范围及分布规律。     

顺腋纹平行双切口保留真皮血管网切除顶泌汗腺治疗腋臭

目的：评价肿胀麻醉下顺腋纹平行双切口保留真皮血管网的顶泌汗腺切除术根治腋臭的疗效.方法：手术顺腋纹做两个平行切口,于腋浅筋膜浅层向四周锐性分离皮下组织达腋毛边缘,翻转皮瓣直视下逐一修剪顶泌汗腺组织.结果：本组68例共136侧,所有病例切口均I期愈合,无1例发生皮瓣坏死,术后经6～12个月的随访,治愈122侧,治愈率89.71%,显效14侧,显效率10.29%,总有效率100%.术后瘢痕轻微、隐蔽,腋窝皮肤活动性好,上肢功能无影响.结论：肿胀麻醉下顺腋纹平行双切口保留真皮血管网的顶泌汗腺切除术治疗腋臭总有效率高,并发症少,瘢痕小,为目前较理想的根治腋臭的手术治疗方法.     

汗腺疾病

961756 消痔灵治疗腋臭500例/魏铁成…//新药与临床。-1995,14(5).-294 腋臭500例,男118例,女382例。采用消痔灵注射液,为了减轻疼痛,每支(10m1)药液中加1％普鲁卡因5ml,注射量按腋部汗腺面积1ml/cm~2计算。从腋部腋毛区边缘进针分别注射于两侧腋毛分布区域的浅层皮下,从外向内逐段呈扇形注射,使药液达到腋窝大汗腺分布的皮下组织。注药后覆盖无菌纱布,轻揉局部,使药液均匀分布。每次每侧注液量为15～20ml,根据腋毛分布范围而定。结果:痊愈475例,显效25例,总     

小切口剥离修剪法治疗腋臭30例分析

对30例腋臭患者沿腋后线腋毛后缘中部作纵向小切口,真皮与皮下组织间分离,范围至腋毛区外约1.0～2.0 cm,刮匙搔刮皮瓣内侧,再用眼科小剪刀修剪残存脂肪组织、腺体及毛囊组织,术后包扎.随访,本组30例腋臭患者,治愈率93.3%,切口瘢痕不易辨认,双上肢活动均正常.小切口剥离修剪法治疗腋臭,疗效确切,一次性治愈率高.     

深浅两层顶泌汗腺处理法治疗腋臭术后并发症的分析和处理

目的分析探讨深浅两层顶泌汗腺处理法治疗腋臭,其术后并发症出现的原因和处理方法。方法对317例腋臭患者行深浅两层顶泌汗腺处理法治疗腋臭,观察术后并发症,分析原因并及时外科处理。结果 317例患者术后血肿20例(6.3%)、皮下积液12例(3.8%),皮肤瘀斑36例(11.4%),皮肤坏死5例(1.6%),切口裂开34例(10.7%),切口感染16例(5.1%),切口延期愈合71例(22.4%),切口瘢痕23例(7.3%),瘢痕挛缩12例(3.8%),异味残留11例(3.5%),腋毛脱落317例(100%);皮肤外科适当处理后效果满意。结论深浅两层顶泌汗腺处理法治疗腋臭术后并发症的发生与多种因素有关,及时恰当的处理仍可以获得满意的术后效果。     

小切口潜行清除汗腺治疗腋臭

目的：寻求一种简便、有效治疗腋臭的外科于术方法。法：肿胀麻醉下通过1．0cm顺皮纹的小切口，于皮下脂肪层潜行分离一略大于腋毛边界的完整腔隙，用剪刀紧贴皮肤侧，剪除真皮下的脂肪浅层，清除其中的大汗腺及毛囊。果：78例患者均取得了较好的临床效果，无术后血肿、皮瓣坏死等并发症。腋部异味均消失，腋窝部仅留下1．0cm顺皮纹瘢痕。其中56例半年后随访，异味完全消失、瘢痕不明显：结论：小切口潜行清除汗腺术治疗腋臭是一种并发症少、瘢痕小、效果好的腋臭手术方法?     

改良“W”或“M”形切口在腋臭治疗中的应用

目的：探讨一种改良“W”或“M”形切口在腋臭外科手术治疗中的应用。方法：先沿腋窝腋毛分布区与正常皮肤交界处划线，再在上臂和侧胸腋毛分布区接近正常皮肤处做上下对称的“W”或“M”形切口设计手术切口线，切开皮肤后，剪除腋毛区域及周围约1CHI皮肤上的脂肪组织、顶泌汗腺及毛囊，修剪成仅含皮肤全层和真皮下血管网的超薄皮瓣，最后缝合切口。结果：2006～2008年5月笔者应用改良“W”或“M”形切口治疗23例腋臭患者（女17例，男6例），所有患者均获随访，最短时间为6个月，23例患者获得满意效果，无一例出现皮肤边缘坏死。结论：改良“W”或“M”形切口手术切口小，手术在直视下破坏顶泌汗腺，手术彻底，操作简单，术后切口瘢痕不明显，术区皮肤柔软，可达到患者美容要求。由于手术并不切除腋窝皮肤，术后患者上肢功能不受影响。本法缺点是术区部分毛囊破坏，腋毛脱落。     

小切口修剪术治疗腋臭

目的 探讨小切口顶泌汗腺非暴露修剪术治疗腋臭的可行性。 方法 对58例腋臭患者施行了小切口顶泌汗腺非暴露修剪术。 结果 随访1~12个月,除1例还有轻度异味外,其余57例治愈。每例（双侧）平均手术时间为55分钟。 结论 这是一种可广泛应用的、简便的、安全的、有良好效果的手术方式。     

汗腺疾病

20140860改良双“M”形切口在腋臭手术治疗中的临床应用／刘瑞（云南红河州建水县医院皮肤科）,石娜,姚经伟…∥皮肤病与性病．．2013,35（2）．-100～101 2008年1月-2012年1月间选择178例腋臭患者,分别采用改良双“M”形切口、腋中线大切口手术剪除顶泌汗腺两种术式,随访1年。对复发率、瘢痕长度和皮瓣坏死率等进行对比。结果：改良双“M”形切口组的复发率和坏死率均低于腋中线大切口治疗组,瘢痕长度改良双“M”形切口组短于腋中线大切口治疗组。参4（杨帆）     

汗腺疾病

973192 酒精注射加电灼法治疗腋臭的临床疗效观察/李兴…//皮肤病与性病。-1997,19（1）。-28 单纯电灼法局麻后扎针范围包括腋毛分布区外1cm处皮肤,无腋毛处均匀排列进行,针距3～4mm,有腋毛处沿毛孔垂直进针。复合法以95%酒精与2%普鲁卡因混合液每侧20～30ml作局部浸润麻醉,仅电灼腋毛分布区域,以40～60度斜行扎入毛孔。两法进针深度均为5～8mm,烧灼0.5～1.0秒,术华酒精纱布包扎,每日换药一次,5～8天创面脱痂而愈。结果两法相比一次治愈率差别有显著性（P<0.001）,皮肤坏死率无显著差别（P>0.05）。（张孝友）     

腋臭病因和发病机制的研究进展

腋臭的病因和发病机制至今尚在研究中。ApoD蛋白可能是腋臭发生分子机制中的核心蛋白,研究表明,顶泌汗腺的分泌物E-3M2H可能借助ApoD蛋白为载体,从体表散发出典型的辛辣气味。ApoD基因自身及其调控因素的差异可能是疾病发生的重要原因之一。在上述过程中,微生物的调控、雄激素及其受体可能在腋臭发病的过程中起了重要作用。腋臭相关基因（ABCC11）中的单核甘酸多态性（SNP很可能是患者发病的决定性因素。     

Minimally Invasive Surgery for Axillary Osmidrosis Using a Combination of Subcutaneous Tissue Removal and a 1,444-nm Nd:YAG Laser

Many treatment modalities have been developed for axillary osmidrosis. It is well known that the surgical treatment has the best results. However, there is a high possibility of side effects. The 1,444-nm lipolysis laser has been recently introduced to remove the apocrine glands. So far, subdermal coagulation treatment with a 1,444-nm Nd:YAG laser may be the least invasive and most effective therapy for axillary osmidrosis. However, according to our previous experience, the recurrence rate was 20%~30%. This emphasizes the need for combination of surgical method and non-surgical method and we combined subcutaneous tissue removal and photothermocoagulation with a 1,444-nm Nd:YAG laser. Three patients for bilateral axillary osmidrosis were enrolled. After an incision of about one-third the length of the widest transverse diameter, the apocrine glands were separated from the skin. And then apocrine glands within the marked area were destroyed by irradiation with a 1,444-nm Nd:YAG laser thereafter. All patients exhibited no relapse of axillary osmidrosis and were satisfied with the treatment results. A combination of subcutaneous tissue removal and Interstitial laser photothermocoagulation with a 1,444-nm Nd:YAG laser could be an effective treatment for mild to moderate axillary osmidrosis.     

Surgical subcision as a cost-effective and minimally invasive treatment for axillary osmidrosis

Background Axillary osmidrosis, characterized by unpleasant odor and occasional staining of clothing, is a personal discomfort and social impairment for people who suffer from it. Various types of surgical procedures involving instrumented‐assisted tools (lasers, ultrasonic, endoscope, and others) have shown relatively positive results; however, for patients in developing countries, especially in China, these treatments are inconvenient and cost‐ineffective. Objective To introduce a minimal incision surgical procedure with skin flap treatment that removes the apocrine sweat glands in the subcutaneous tissue through a 1‐cm‐long incision without instrument‐assisted tools. Method From July 2005 to October of 2007, 108 patients (68 women and 40 men) were treated with the minimal incision and cost‐effective surgical treatment by manual excision. A 1‐cm‐long incision is made in the axillary crease. Subcutaneous tissue and glands were removed with scissors through this incision. This procedure is repeated throughout the entire axilla until the axilla has essentially become a super‐thin flap. Result Malodor elimination was good in 206 out of 215 axillae (95.8%) treated, fair in nine (4.2%), and poor in zero (0%). The resulting scar is small and virtually invisible because it is only 1‐cm long and located in the axillary crease. Conclusion Treatment of axillary osmidrosis by manual excision through a 1‐cm incision is a convenient, efficient, cost‐effective, and relatively safe technique that results in high patient satisfaction and benefits patients and surgeons in developing countries. Axillary osmidrosis, a non‐life‐threatening condition characterized by unpleasant odor and occasional staining of clothing, is an annoying problem, particularly in Asian societies. For many people who suffer from this problem, this condition is a personal discomfort, a social impairment, and discourages patients from enjoying social or personal activities, especially young women. They are usually embarrassed by the smell during their daily activities and communication with other people.     

Tumescent superficial liposuction with curettage for treatment of axillary bromhidrosis

Backgrounds Axillary bromhidrosis is a common but unpleasant and distressing problem faced by many societies, particularly in Asia, where malodour is reflected as a social handicap. Currently, local surgery is the treatment of choice among various non‐surgical and surgical treatment. Objectives To evaluate the clinical efficacy and safety of tumescent superficial liposuction and curettage in treating axillary bromhidrosis. Methods Forty‐three patients (25 females and 18 males, average age 24.5 years) have undergone tumescent superficial liposuction and curettage. Local anaesthesia, tumescent solution, was injected into the hair‐bearing area of the axilla. Two tiny incisions were made for Fatemi cannule, and subcutaneous tissue was removed by stroke movement under negative pressure. Subsequently, additional curettage was done around the incision sites. We evaluated the clinical efficacy (excellent, good, fair and poor) and complications. In addition, preoperative and postoperative histologic findings were reviewed in 15 patients. Results The follow‐up evaluation started 3 months after the surgery, and mean follow‐up period was 15.8 months, ranging from 3 to 54 months. Among 43 patients, 31 patients (72.1%) showed excellent to good results. The most common postoperative complication was transient ecchymosis which spontaneously regressed in 1 to 2 weeks. Focal skin necrosis, induration, and haematoma or seroma were each noted in four, three, and one patients, respectively, but resolved after proper dressing. The preoperative histological findings included increase in size and number of apocrine glands in cross‐section view, and the postoperative specimen evidently showed removal of subcutaneous tissue, including apocrine and eccrine glands, and remnant sweat glands were severely destructed. Conclusion Tumescent superficial liposuction with curettage for axillary bromhidrosis is an effective and safe treatment method for axillary bromhidrosis.     

不累及腋臭手术部位的间擦疹型手足综合征一例国际首报

【摘要】 患者女,25岁,因手足、腋下和腹股沟红斑水疱伴疼痛反复1个月就诊。7年前患者因腋臭双腋下曾行小切口汗腺切除术。1个月前因颈部滑膜肉瘤（ⅡB期）术后行多柔比星脂质体化疗,3次化疗期间,出现手足、腋下和腹股沟红斑水疱伴疼痛,皮损逐次加重。皮肤科检查：双手掌、足跖及腋下、腹股沟等间擦部位可见大片水肿性红斑,边界较清楚,上有粟粒至黄豆大小水疱,可见糜烂;皮疹处皮温高,触痛明显,尼氏征阳性;双腋下行小切口腋臭手术的部位无皮损,无疼痛。腋下皮损组织病理检查：基底层下水疱形成及部分汗腺坏死。诊断：多柔比星脂质体相关间擦疹型手足综合征。根据该病例合并腋臭手术史,手术部位皮肤正常,推测该病发病机制可能为药物经汗腺排泄到皮肤后诱发的皮肤毒性反应。     

The absence of apoeccrine glands in the human axilla has disease pathogenetic implications, including axillary hyperhidrosis

BACKGROUND: The existence of a third type of sweat gland in human axillary skin, the apoeccrine gland, with a capacity to produce much higher sweat output than the eccrine gland, was proposed from examination of microdissected glands. However, previous studies of axillary skin glands did not examine the entire individual glandular structure via serial sections and the markers used to identify the different glands gave conflicting results and, hence, the existence of the apoeccrine gland remains controversial. OBJECTIVES: To investigate human axillary sweat glands by serial section histology and immunofluorescence. METHODS: Human axillary sweat glands were investigated by serial sectioning of paraffin wax-embedded skin samples taken by biopsy from four male and six female volunteers (age range 20-35 years). Sections were examined by light microscopy and immunofluorescence, using antibodies to antigens reported to be markers for discriminating between eccrine and apocrine gland cells: CD15, CD44, S100 and human milk fat globulin. RESULTS: Light microscopy demonstrated that there were hair follicles and a mean +/- SD of 76 +/- 14 sweat glands cm(-2). Eccrine and apocrine glands were found to be present; however, no glands resembling the apoeccrine glands were detected. Both types of sweat gland exhibited signs of being active, with segments of the secretory coils displaying flattened cells and dilated glandular lumina; however, this dilation did not extend to obvious changes in the width of the gland. None of the eccrine glands exhibited evidence of the presence of apocrine cells or vice versa. Immunofluorescence markers were found not to be specific and did not discriminate between the different types of glands or demonstrate the presence of apoeccrine glands. CONCLUSIONS: This is the first time that serial sections of axillary skin have been examined by histology and immunofluorescence. The markers reported to discriminate between apocrine and eccrine glands were found to be nonspecific. No evidence of apoeccrine glands was found either by histology or by immunofluorescence.     

肿胀麻醉下微切口负压抽刮法治疗腋臭110例

目地 探讨一种微创、有效、安全的腋臭治疗方法。方法 沿腋毛分布边缘标记手术区域,应用肿胀麻醉技术分两层注入肿胀液,分步骤交叉置入抽指针、放射状负压抽刮术区治疗腋臭,术区加压固定。结果 自2009年4月至2010年7月共收治110例,随访3-18个月,总有效率为100％ 。结论 本法操作简单,效果确切,恢复快,术后基本不留皮肤疤痕,值得推广应用。     

Excision of apocrine glands and axillary superficial fascia as a single entity for the treatment of axillary bromhidrosis

Background Surgical excision of apocrine glands is the effective treatment for axillary bromhidrosis. Skin necrosis, the most serious adverse result observed postoperatively, results in a prolonged wound healing and leads to unsightly scars in the axillary fossae. It is mainly caused by the skin damage during the operation and postoperative seroma or haematoma formation. Objective To investigate the effects and complications of our surgical modality for axillary bromhidrosis. Methods Sixty‐three patients with bromhidrosis were treated. An incision about two‐thirds of the length of the widest transverse diameter was made on the axillary crease. The loosened layers between the dermis and axillary superficial fascia containing apocrine glands were carefully undermined with an iris scissor. The entire apocrine glands‐axillary superficial fascia complex was dissected from the centre to the superior and inferior margins with an electrosurgical pencil. Results Of the 126 axillae, malodour was eradicated in 112 axillae and reduced sharply in 14. There were three cases of skin necroses. The Dermatology Life Quality Index score decreased significantly and the quality of life improved after the operation. Conclusion Our surgical technique can achieve minimal tissue damage and maintain no hematoma postoperatively. The rate of skin necrosis was low. Quality of life improved after the procedure in this patient population.     

Local injection of botulinum toxin A: An alternative therapy for axillary osmidrosis

The objective of this study was to investigate the efficacy of local injection of botulinum toxin A for treating axillary osmidrosis. One hundred and fifty patients with axillary osmidrosis were randomly divided to receive botulinum toxin A injection treatment (50 U of botulinum toxin A was injected intracutaneously into 6–20 different sites within each axilla, n = 74) or surgical excision of the apocrine glands (n = 76). The patients were followed up for 1–3 months to analyze the therapeutic effect and complications of the two methods. The curative effect in patients with mild and moderate axillary osmidrosis was not significantly different between the botulinum toxin A injection group and operation group. However, for patients with severe axillary osmidrosis, surgery treatment seemed to be superior to botulinum toxin A treatment (P = 0.005). There was also no significant difference in the modified Dermatology Life Quality Index between the two treatments. Two cases showed complications related to hemorrhage and incision infection in the operation group. In conclusion, local injection of botulinum toxin A is a safe, fast and effective treatment for mild and moderate axillary osmidrosis, but the long‐term effect remains to be further investigated.