陳波 朱雄翔 張冬梅 郭晶東 朱鎮(zhèn)森 彭靚

[摘要]目的：探討負壓抽吸聯(lián)合搔刮法與小切口皮下剪除法治療腋臭的臨床療效及安全性。方法：2017年1月-2019年6月筆者科室治療腋臭應用負壓抽吸聯(lián)合搔刮法55例，小切口皮下剪除法40例，術(shù)后隨訪6～12個月，比較兩種手術(shù)方法術(shù)后有效性及并發(fā)癥情況。結(jié)果：負壓抽吸聯(lián)合搔刮法治療腋臭的有效性與小切口皮下剪除法比較差異無統(tǒng)計學意義（P>0.05）;而其并發(fā)癥發(fā)生率低于小切口皮下剪除法，差異有統(tǒng)計學意義（P<0.05）。結(jié)論：負壓抽吸聯(lián)合搔刮法治療腋臭并發(fā)癥更低，瘢痕更輕，是一種值得推薦的腋臭手術(shù)治療方法。

[關(guān)鍵詞]腋臭;負壓抽吸;搔刮;皮下剪除;小切口;療效

[中圖分類號]R758.74+1? ? [文獻標志碼]A? ? [文章編號]1008-6455（2021）03-0067-02

Comparison of Negative Pressure Suction Combined with Scratching and Small Incision Subcutaneous Pruning in the Treatment of Axillary Bromhidrosis

CHEN Bo，ZHU Xiong-xiang，ZHANG Dong-mei，GUO Jing-dong，ZHU Zhen-sen，PENG Liang

（Department of Burns and Plastic Surgery，Shenzhen Hospital of Southern Medical University，Shenzhen 518000，Guangdong，China）

Abstract： Objective? To observe the clinical efficacy and safety of negative pressure suction combined with scratching and small incision subcutaneous pruning in the treatment of axillary bromhidrosis. Methods? From January 2017 to June 2019，95 patients were included and divided into two groups（55 cases by negative pressure suction combined with scratching， 40 cases by small incision subcutaneous pruning）. The patients were followed up for 6 to 12 months. The effectiveness and complications of the two methods were compared. Results? There was no significant difference in curative effect between the two groups（P>0.05）. The complication rate of negative pressure suction combined with scratching was lower than that of small incision subcutaneous pruning， the difference was statistically significant（P<0.05）. Conclusion? Negative pressure suction combined with scratching in the treatment of axillary bromhidrosis has lower complications and lighter scar， which is a recommended surgical treatment for axillary osmidrosis.

Key words： axillary bromhidrosis; negative pressure suction; scratching; subcutaneous pruning; small incision; curative effect

腋臭（Axillary bromhidrosis）俗稱狐臭，是人體大汗腺過度分泌的產(chǎn)物在需氧棒狀桿菌的分解下產(chǎn)生的特殊難聞氣味。負壓抽吸聯(lián)合搔刮法與小切口皮下剪除法是目前最廣泛應用于臨床的兩種手術(shù)治療方法。本研究收集了2017年1月-2019年6月筆者科室應用兩種治療方法的患者資料，為臨床選擇提供一些參考。

1? 臨床資料

本組共95例患者，男性22例，女性73例;年齡15～42歲，平均23.5歲，67例患者直系親屬中有腋臭發(fā)生。所有患者無手術(shù)外傷史，腋下淋巴結(jié)無腫大，皮膚無紅腫疼痛，血常規(guī)及凝血功能正常。按照不同手術(shù)方法分為負壓抽吸聯(lián)合搔刮組（55例，110側(cè)）和小切口皮下剪除組（40例，80側(cè)）。

2? 治療方法

2.1 負壓抽吸聯(lián)合搔刮組：患者仰臥，雙手抱頭。備皮刀刮除腋毛，術(shù)區(qū)常規(guī)消毒鋪巾，亞甲藍標記手術(shù)范圍為腋毛邊緣外1cm，沿上臂腋毛遠端設(shè)計5mm長的橫向手術(shù)切口。250ml生理鹽水+2%利多卡因20ml+腎上腺素0.25mg行腫脹麻醉，每側(cè)約100ml，腫脹麻醉層次位于皮下與淺筋膜層。用長的鈍頭組織剪沿皮下脂肪淺層分離，用前端呈鋸齒樣腋臭抽吸搔刮器接100kPa負壓行皮下汗腺搔刮抽吸（見圖1～2），搔刮器的吸引孔朝外，先沿腋毛縱軸扇行抽吸，然后沿腋毛橫軸行漸進橫向抽吸。搔刮至皮膚厚度2～3mm，厚度相當于全厚皮。生理鹽水行皮下沖洗后擠出沖洗液，縫合1針，不打結(jié)，待第2天皮下滲液充分引流后打結(jié)關(guān)閉傷口。術(shù)后無菌敷料覆蓋，并用筆者科室特制腋臭包扎袖帶固定（見圖3），術(shù)后7d拆線。