顺腋纹小切口超薄皮瓣法腋臭根治术

目的:探讨顺腋纹小切口超薄皮瓣腋臭根治术的方法.方法:2002年1月～2008年4月,对我科60例腋臭患者,采用局部肿胀麻醉方法,沿腋纹做两个小切口,彻底修剪皮下毛囊以及大小汗腺组织,修剪成为超薄皮瓣,达到腋臭根治目的.并对患者进行随访4个月～1年.结果:58例患者Ⅰ期愈合,切口极其隐蔽,切口瘢痕很小,腋臭气味消失.1例患者切口超薄皮瓣下少量积血,清除积血后愈合.1例患者切口感染裂开后约为1cm,经过抗感染和换药后Ⅱ期愈合.结论:顺腋纹小切口超薄皮瓣法根治腋臭的方法,手术切口隐蔽,术后切口瘢痕小,效果好,并发症发生率低,患者对术后切口外形满意率较高.     

顺腋纹小切口腋臭根治术并发症的处理和分析

目的：探讨顺腋纹小切口腋臭根治术后并发症出现的原因和处理方法。方法：回顾187例顺腋纹小切口腋臭根治术的病例资料,统计术后发生并发症的情况,分析其出现的原因,阐述防治措施。结果：187例患者中有26例发生术后并发症,其中血肿6例（3.21%）,切缘愈合不良10例（5.35%）,皮肤坏死2例（1.07%）,异味残留8例（4.28%）。结论：顺腋纹小切口腋臭根治术具有创伤小、切口隐蔽、外形美观、无功能障碍的优点,术中操作规范,采取相应的措施可以减少并发症的发生。     

直视下顺腋纹小切口腋臭根治术的疗效及并发症分析

目的:探讨直视下顺腋纹小切口腋臭根治术的疗效及并发症。方法:直视下顺腋纹小切口修剪顶泌汗腺,观察术后疗效,统计术后并发症发生率,分析其出现的原因,以期采取更好的防治措施。结果:118例患者中,116例(98%)术后疗效肯定,18例(15.25%)发生术后并发症,包括15例(12.71%)切口愈合不良,2例(1.69%)血肿,1例(0.85%)异味残留,无皮瓣坏死及神经损伤,术后切口瘢痕轻微。结论:直视下顺腋纹小切口腋臭根治术疗效肯定,并发症少,值得临床推广。     

螺旋桨形皮瓣治疗腋臭术后皮肤缺损

腋臭的治疗方法很多,目前,通过手术方法去除部分腋部皮肤组织仍是公认的根治腋臭症的最佳方法[1],因为去除部分皮肤组织伤口愈合后会出现明显的瘢痕,后来很多人研究保留皮肤的腋臭根治术,腋后线"W"形小切口腋臭剥离术[2]、改良"Z"形切口根治术治疗腋臭[3]、腋纹小切口超薄皮瓣法治疗腋臭[4]、微创手术治疗腋臭[5]、保留真皮下血管网皮瓣法治     

螺旋桨形皮瓣治疗腋臭术后皮肤缺损

腋臭的治疗方法很多,目前,通过手术方法去除部分腋部皮肤组织仍是公认的根治腋臭症的最佳方法[1],因为去除部分皮肤组织伤口愈合后会出现明显的瘢痕,后来很多人研究保留皮肤的腋臭根治术,腋后线"W"形小切口腋臭剥离术[2]、改良"Z"形切口根治术治疗腋臭[3]、腋纹小切口超薄皮瓣法治疗腋臭[4]、微创手术治疗腋臭[5]、保留真皮下血管网皮瓣法治     

微波照射对腋纹切口皮瓣法腋臭术后伤口愈合的影响

目的：探讨微波照射对腋纹切口皮瓣法腋臭术后伤口愈合的影响,以及微波治疗在腋臭术后运用的前景。方法：将20例门诊行腋纹切口皮瓣法腋臭手术患者随机分成2组,实验组术后微波照射术区,对照组术后常规换药护理,观察腋部皮瓣血运及术口愈合情况,对各组伤口I期愈合率进行比较。结果：实验组愈合时间平均7.3天I,期愈合率95.0%。对照组愈合时间平均10.4天I,期愈合率75.0%。实验组术后伤口愈合时间和I期愈合率均显著优于对照组（P〈0.05）。结论：采用腋纹切口皮瓣法腋臭术后3天开始行创面微波照射,可促进腋部皮瓣局部血液循环和皮瓣成活,减少并发症,利于切口愈合。     

改良的顺腋纹小切口法腋臭根治术

目的:探讨一种改良的小切口腋臭根治术的方法。方法:从2006年1月至2007年1月我们改良了顺腋纹小切口法腋臭根治术,治疗50例腋臭患者,所有患者均进行随访。结果:49例I期愈合,切口隐蔽,瘢痕不明显,气味消失。1例切口中间裂开1mm,加强换药一次后愈合。结论:改良的小切口腋臭根治术是一种切口隐蔽,无附加痕迹,操作方便,效果确切,并发症发生率低的术式。     

顺腋纹小切口腋臭根治术几个问题的探讨

目的 探讨顺腋纹小切口腋臭根治术的最佳手术方式和几个问题.方法 在局部阻滞浸润麻醉下,沿腋窝皱襞做一长3.0～5.0cm的小切口,在浅深筋膜之间锐性剥离至或略超出腋毛区边缘0.5cm,翻转皮瓣,剪除附着于真皮基底的所有皮下组织,形成超薄皮瓣,彻底止血,戳引流口后缝合手术切口,碎无菌纱布填塞腋窝,棉垫覆盖后"8"字绷带加压包扎.自2006 年8月至2010 年6 月,对120例患者实施了腋臭根治术.结果 107 例患者手术切口Ⅰ期愈合,瘢痕不明显;余13例患者中,单侧出现皮下血肿者4例,单侧出现皮瓣表皮糜烂者9例,经换药处理后愈合.所有患者的臭味均消失.术后随访120例患者3个月至2年,无复发者.结论 本术式操作简单、科学实用、效果可靠、并发症少,值得推广使用.     

保留真皮下血管网汗腺清除法在腋臭根治术中的应用

目的：探讨一种简单实用、疗效确切、并发症少的腋臭根治术式。方法：选择2015年12月-2020年11月诊治的腋臭患者228例（456侧）为研究对象，采用保留真皮下血管网超薄皮瓣并清除汗腺的方法根治腋臭。术前在腋毛边缘外扩0.5～1.0 cm处标记手术范围后剃除腋毛；术区内顺腋横纹方向标记2条平行切口线，使得切开后形成的双蒂皮瓣长宽比例不超过2.5:1；在直视状态下剪除皮瓣上附着的皮下脂肪、大汗腺以及毛囊等组织，并保留真皮下血管网，形成带真皮下血管网的超薄皮瓣；术毕打包加压固定。结果：本组病例228例（456侧），治愈435侧，显效21侧，无效0侧。结论：该方法具有操作安全简单，痛苦小，并发症少，疗效好，术后外观符合美学要求等特点。     

腋臭微创清除术50例临床报告

目的:探讨一种切口小、痛苦少、疗效佳的腋臭手术方法.方法:用眼科小剪刀剪除真皮下脂肪浅层,清除其中的大汗腺及毛囊.结果:本组50例患者100侧术后腋部异味完全消失,腋窝部仅留下1.0cm顺皮纹瘢痕.50例术后随访2个月～2年,异味完全消失,无术后血肿、皮瓣坏死及功能障碍等并发症.结论:腋臭微创清除术治疗腋臭是一种切口小、痛苦少、瘢痕小、效果好的腋臭手术方法.     

腋窝单孔与双乳晕腋窝径路甲状腺手术的比较

目的对比完全内镜双乳晕同侧腋窝径路和完全经腋窝单孔甲状腺手术的临床效果、可行性、安全性。方法回顾性分析2011年5月-2013年9月在我院经完全内镜双乳晕同侧腋窝径路甲状腺手术（BBIAA）和经腋窝单孔甲状腺手术（TASPET）62例患者的临床资料,每组31例患者,比较两组患者的手术时间、手术分离皮瓣面积、手术出血量,术后第一天引流量、VAS疼痛评分、C-反应蛋白（CRP）,以及术后并发症。结果 62例患者均顺利完成手术,随访2～8个月,无复发。两组术中的出血量、术后第一天的引流量无明显差异。BBIAA组的手术时间明显较TASPET组短（P〈0.05）,术后第一天的VAS评分和CRP明显较TASPET组低（P〈0.05）,手术分离的皮瓣面积明显较TASPET组小（P〈0.05）,术后的并发症明显比TASPET组少（P〈0.05）。结论 TASPET和BBIAA两种手术方法均具有很好的美容效果。但综合考虑,BBIAA手术更简便,同时手术创伤小、术后并发症少及术后疼痛轻,是一种值得推广的内镜甲状腺手术径路。     

Electrothermal bipolar vessel sealing system in axillary dissection: a prospective randomized clinical study

We assessed whether axillary dissection using the electrothermal bipolar vessel sealing system (LigaSure) improved perioperative outcome when compared with conventional axillary dissection, in a prospective randomized study of 100 women with breast cancer. Those needing axillary dissection were randomized to the use of LigaSure or to conventional axillary dissection (with 50 patients in each group, all of whom had a closed suction drain in the axilla). The LigaSure patients had less intraoperative blood loss (exceeding 199 mL in 30.8% vs. 69.2%, P < 0.001), quicker axillary dissection (mean 48 vs. 63.2 min, P = 0.004), fewer days of suction drainage (4.3 vs. 5.7 days, P = 0.012), and shorter hospitalization (5.1 vs. 6.5 days, P = 0.021). No difference was found in the rate of hematomas, reoperations or infection. The use of LigaSure in axillary surgery reduced the surgical time and length of hospital stay, favoring early drain removal without increasing postoperative complications.     

Ultrasound-guided block of the axillary nerve: a case series of potential clinical applications

The specific blocking of the axillary nerve has never been investigated clinically. We present four cases illustrating potential applications of the axillary nerve block in the perioperative setting and discuss possible directions for future research in this area. The axillary nerve blocks were all performed using a newly developed in-plane ultrasound-guided technique. In one patient undergoing arthroscopic shoulder surgery, we used the axillary nerve block as the only analgesic combined with propofol sedation and spontaneous breathing. Chronic shoulder pain was eliminated after the axillary nerve block in two patients. The pain score after arthroscopic shoulder surgery in these two patients remained low until termination of the nerve block. In a fourth patient, severe post-operative pain after osteosynthesis of a displaced proximal humerus fracture was almost eliminated after performing an axillary nerve block. These findings warrant larger clinical trials that investigate the pain-mediating role of the axillary nerve in the perioperative setting.     

Cannulation of the right axillary artery for surgery of acute type A aortic dissection.

OBJECTIVE: The optimal choice of the arterial inflow site during operations for type A aortic dissection is not clearly defined. The aim of the prospective study was to identify whether cannulation of the right axillary artery instead of the femoral artery may improve the results of surgery for acute type A aortic dissection. METHODS: Seventy consecutive patients were operated on because of acute type A aortic dissection from January 2000 to February 2002. The only difference in surgical strategy was the site of arterial cannulation: the right axillary artery was used in 20 patients [axillary group] and the left femoral artery in 50 patients [femoral group]. All patients had aortic surgery with open distal anastomosis during deep hypothermic arrest and retrograde cerebral perfusion. The mean age was 58.7 +/- 12 years with a range from 28 to 88 years (axillary group, 56.6 +/- 13 years; femoral group, 59.4 +/- 12 years; P = 0.435). Preoperatively evident organ malperfusion was identified in five (25%) patients of the axillary group and in seven (14%) of the femoral group. RESULTS: There was no perioperative death. The hospital mortality rate was 5.0% for the axillary group and 22% for the femoral group (all patients, 17%). Major neurological complications occurred postoperatively in 5% of patients from the axillary group (one out of 20 patients) and in 8% of patients from the femoral group (four out of 50 patients) (all patients, 7%). CONCLUSION: Cannulation of the right axillary artery improved the outcome of surgery for acute type A aortic dissection. However, postoperative complications occurred after both axillary and femoral artery cannulation.     

腋后线沿皮纹横行小切口在搔刮法腋臭根治术中的应用

目的:探讨腋臭根治术更理想的微创手术方式。方法:作者手术治疗了280例(560侧)患有双侧腋臭的患者,应用腋后线沿皮纹横行小切口搔刮法腋臭根治术140例(实验组),应用腋窝横皱襞小切口搔刮法腋臭根治术140例(对照组),观察记录每例患者双侧手术总的时间、术后有无血肿、术后有无切口边缘坏死或糜烂及治疗效果。结果:①实验组140例手术时间均值为(60±2)mi n,对照组140例手术时间均值为(110±2)mi n,两者有统计学差异(t=220.17,P<0.05);②实验组术后未出现皮下血肿,而对照组1例单侧术后出现皮下血肿,两者无显著性差异(P=0.5);③实验组术后无切口边缘坏死或糜烂,对照组6例(8侧)出现术后切口边缘坏死或糜烂,两者有显著性差异(P=0.0148);④所有患者随访1年,实验组136例治愈,4例有效,总有效率100%,治愈率97.14%;而对照组135例治愈,5例有效,总有效率100%,治愈率96.43%;两者治愈率无显著性差异(χ2=0.0094,P>0.05)。结论:应用腋后线沿皮纹横行小切口行腋臭根治术,术者手术操作方便,手术时间短,无切口边缘坏死或糜烂,并发症少,治愈率高,是值得推广的一种手术方式。     

Management of axillary burn contractures

This article will review the basic principles and techniques of managing axillary burn contractures in both industrialized and developing nations. Surgeons specializing in hand and upper extremity surgery should be adept in treating axillary soft tissue deficits secondary to burn contractures. The focus of this article will be to provide suggestions for performing skin grafts and latissimus dorsi musculocutaneous flaps, as well as illustrate guidelines for postoperative rehabilitation.     

The technique and efficacy of axillary catheter analgesia as an adjunct to distraction elbow arthroplasty: A prospective study

A prospective study was done on 99 consecutive patients who underwent distraction elbow arthroplasty and postoperative continuous passive motion from 1986 to 1992. Postoperative axillary catheter infusion in 73 patients was compared with patient-controlled analgesia-opioid treatment in 26 patients. Group comparisons for analgesia, complications, time to initiation, and tolerance of postoperative continuous passive motion were made. The postoperative axillary catheter infusion group was more comfortable and had better postoperative continuous passive motion compliance than did the patient-controlled analgesia-opioid group. The postoperative axillary catheter infusion group had a 2.7% (2 of 73) incidence of respiratory toxicity. There was an 11.5% (3 of 26) incidence of respiratory depression in the patient-controlled analgesia-opioid group. Final arc range of motion was similar between postoperative axillary catheter infusion and patient-controlled analgesia-opioid groups. The data support the hypothesis that postoperative axillary catheter infusion provides better patient comfort and earlier postoperative continuous passive motion initiation, but they do not show additional improvement in the final arc of motion after distraction elbow arthroplasty as compared with a patient-controlled analgesia-opioid treatment group.     

床旁超声监测腋静脉变异度在围术期容量管理的应用进展

评估患者的容量状态以及容量反应性可以指导临床医师对围术期患者容量进行合理管理，也可以指导麻醉过程中的容量治疗，有助于患者快速康复。目前，床旁超声可视化技术已被广泛应用于围术期容量评估。腋静脉超声因其操作简单、无创以及不受腹内压影响等优点，已被应用于评估患者的容量状态。本文对床旁超声监测腋静脉变异度在围术期患者容量管理中的应用进展进行综述，以期为围术期患者的容量管理和容量治疗提供参考。     

Endoscopic axillary surgery in breast cancer

BACKGROUND: The aim was to provide an assessment of the current status of endoscopic axillary surgery in patients with breast cancer. METHODS: Fifty-three patients underwent endoscopic lymphadenectomy. The surgical efficiency (operating time, number of resected nodes, intraoperative and postoperative complications), short-term morbidity (duration of drainage, total lymph flow, seroma rate) and long-term outcome (pain, numbness, mobility, strength, oedema) were assessed. The incidence and severity of different arm symptoms were compared with the results of 396 patients treated with a conventional axillary procedure. Finally, all available data relating to endoscopic axillary surgery were reviewed. RESULTS: The operating time ranged from 60 to 150 min. A mean 17 (range 10-28) lymph nodes was resected. The extent of postoperative lymphorrhoea (mean 372 ml) and the seroma rate (eight of 34 patients) were not significantly reduced in comparison with conventional surgery. The assessment of long-term morbidity revealed fewer disturbances of sensitivity and a decreased rate of severe symptom intensity for pain, oedema and complaints related to mobility. CONCLUSION: Despite excellent visualization of anatomical landmarks and improved long-term morbidity, endoscopic lymph node dissection cannot be regarded as a suitable technique for routine axillary management in breast cancer because of long operating times.