腋皱襞小切口治疗腋臭39例疗效观察及组织学分析

目的:观察腋皱襞小切口治疗腋臭的临床效果，同时分析腋窝大汗腺的组织学结构，进一步明确大汗腺的分布层次及范围，指导手术治疗。方法:选取39例腋臭病人，均采用腋皱襞小切口手术治疗（A组），分离范围超出腋毛范围0.5cm，选取腋窝皮肤松弛的病人在腋窝中央和腋毛外缘0.5～1.0cm处切取其皮肤组织，深度均至脂肪层，送病理行组织学分析，观察大汗腺的层次、范围等。另回顾性分析30例病人采用肿胀麻醉下大汗腺搔刮术治疗腋臭（B组）的术后并发症发生率，并与腋皱襞小切口治疗腋臭的并发症发生率进行比较。结果:A组总有效率达97.44%，B组总有效率达80.00%，A组治疗效果优于B组（P<0.05）。2组术后并发症发生率差异无统计学意义（P>0.05）。A组送检标本病理切片显示均检测出大汗腺，其集中分布于真皮深层、真皮脂肪交界区和脂肪浅层内。距离腋毛边缘0.5 cm处有少量大汗腺组织，边缘1.0 cm处无大汗腺组织，脂肪深层未观察到大汗腺组织。结论:腋皱襞小切口治疗腋臭术后疗效可靠，术后复发率低于肿胀麻醉下大汗腺搔刮术，但术中应注意修剪大汗腺的深度及广度，值得临床推广。

Effect observation and histological analysis of the small incision of axillary fold in the treatment of axillary osmidrosis in 39 cases

Objective: To observe the clinical effects of the small incision of axillary fold in treating axillary osmidrosis,analyze the histological structure of apocrine sweat glands,further clarify the distribution and range of apocrine sweat glands,and guide the operation treatment.Methods: Thirty-nine patients with osmidrosis were treated with the small incision of axillary fold(groupA).The separation range was 0.5 cm beyond the axillary hair range,the skin tissue at the center of the axilla and 0.5-1.0 cm distance from the outer edge of the axilla,the depth was down to the adipose layer,was cut and detected using histology in patients with axillary skin laxity,and the layers and range of large sweat glands in group A were observed.The incidence rate of postoperative complications in 30 patients treated with large sweat gland scratch under swelling anesthesia(group B) was retrospectively analyzed,and which was compared with that of axillary odor treated with small incision of axillary fold.Results: The total effective rates in group A and group B were 97.44% and 80%,respectively.The treatment effect in group A was better than that in group B(P<0.05),and the difference of the incidence rate of postoperative complication between two groups was not statistically significant(P>0.05).The large sweat glands were detected in group A,which was mainly distributed in the dermal layer,dermal fat junction area and fatty superficial layer.A small amount of large sweat gland tissue was found at 0.5 cm away from the edge of axillary hair,and no large sweat gland tissue was found at 1.0 cm away from the edge of axillary hair and deep adipose layer in group A.Conclusions: The small incision of axillary fold in treating axillary osmidrosis is reliable and has low postoperative recurrence rate compared with large sweat gland scratch under tumescent anesthesia,but pruning the depth and width of apocrine glands should be noted during operation,which is worthy of clinical promotion.