腋臭患者腋区顶泌汗腺的分布特点

【摘要】 目的 检测腋臭患者腋区顶泌汗腺在深度、广度的分布，探讨其范围内的分布差异性。 方法 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2 mm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1 cm（点2）、距腋毛边缘内1 cm（点3）、腋毛边缘（点4）、距腋毛边缘外1 cm（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。 结果 顶泌汗腺分泌部主要分布于真皮网状层和皮下脂肪浅层，表皮层、真皮乳头层及腋浅筋膜浅层均无顶泌汗腺分布。顶泌汗腺广度分布与腋毛范围基本一致，腋中心部可见大量顶泌汗腺组织，腋毛边缘处仍有少量顶泌汗腺分布，腋毛边缘外1.0 cm处已无顶泌汗腺分布。5个点顶泌汗腺面积占整块组织面积的百分比平均值分别为74.1%、46.6%、25.3%、2.1%和0，相邻两点进行t检验，点1、2之间t = 29.78，P < 0.01；点2、3之间t = 9.76，P < 0.01；点3、4之间t = 20.83，P < 0.01；点4、5之间t = 1.96，P > 0.05。 结论 手术治疗腋臭时，清除范围深度达真皮网状层和浅层脂肪层，广度到腋毛范围即可，没有必要过度扩大清除范围。

Distribution of apocrine sweat glands in axillary region of patients with axillary osmidrosis

Xing Weibin*, Liu Wenfang, Zhao Zishen, Peng Jun, Li Xingwen, Ma Yuzhi, Wang Na. *Department of Dermatology, Cangzhou People′s Hospital, Cangzhou 061001, Hebei, China Corresponding author: Liu Wenfang, Email: dancing_liu@126.com 【Abstract】 Objective To determine the distribution profile of apocrine sweat glands in axillary region of patients with axillary osmidrosis, and to compare their distribution at different sites. Methods Fifteen patients with axillary osmidrosis were enrolled in this study from September to December 2010. All the patients underwent surgical removal of apocrine sweat glands under direct vision. Full-thickness skin tissue measuring 2 mm in width was excised down to the axillary superficial fascia at the incisional surgical sites from five patients. Five points, which were at the center of axillary region （point 1）, 1 cm away from the center of axillary region（point 2）, 1 cm inside the edge of axillary hair-bearing area （point 3）, the edge of axillary hair-bearing area （point 4）, and 1 cm outside the edge of axillary hair-bearing area （point 5）, were marked, and dark red, rough granular subcutaneous tissue was obtained at these points in 10 patients with axillary osmidrosis. Results The secretory portion of apocrine sweat glands was mainly distributed in the reticular dermis and superficial subcutaneous adipose tissue, but no apocrine sweat glands were observed in the epidermis, dermal papilla or axillary superficial fascia. The distribution profile of apocrine sweat glands was consistent with that of axillary hairs. There were numerous apocrine sweat glands in the center of axillary region, but only a small number at the edge of axillary hair-bearing area, and no apocrine sweat gland was observed at 1 cm outside the edge. The percentage of apocrine sweat gland area at point 1－5 was 74.1%, 46.6%, 25.3%, 2.1%, and 0 respectively, with significant differences between point 1 and 2 （t = 29.78, P < 0.01）, point 2 and 3 （t = 9.76, P < 0.01）, point 3 and 4 （t = 20.83, P < 0.01）, but not between point 4 and 5 （t = 1.96, P > 0.05）. Conclusions During the surgical treatment of axillary osmidrosis, the removal of apocrine sweat glands should be extended to the reticular dermis and superficial subcutaneous adipose tissue in depth and the edge of axillary hair-bearing area in width, and there is no need to blindly increase the extent of removal.