负压抽吸联合搔刮法与小切口皮下剪除法治疗腋臭疗效比较

陈波 朱雄翔 张冬梅 郭晶东 朱镇森 彭靓

[摘要]目的：探讨负压抽吸联合搔刮法与小切口皮下剪除法治疗腋臭的临床疗效及安全性。方法：2017年1月-2019年6月笔者科室治疗腋臭应用负压抽吸联合搔刮法55例，小切口皮下剪除法40例，术后随访6～12个月，比较两种手术方法术后有效性及并发症情况。结果：负压抽吸联合搔刮法治疗腋臭的有效性与小切口皮下剪除法比较差异无统计学意义（P>0.05）;而其并发症发生率低于小切口皮下剪除法，差异有统计学意义（P<0.05）。结论：负压抽吸联合搔刮法治疗腋臭并发症更低，瘢痕更轻，是一种值得推荐的腋臭手术治疗方法。

[关键词]腋臭;负压抽吸;搔刮;皮下剪除;小切口;疗效

[中图分类号]R758.74+1    [文献标志码]A    [文章编号]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，是人体大汗腺过度分泌的产物在需氧棒状杆菌的分解下产生的特殊难闻气味。负压抽吸联合搔刮法与小切口皮下剪除法是目前最广泛应用于临床的两种手术治疗方法。本研究收集了2017年1月-2019年6月笔者科室应用两种治疗方法的患者资料，为临床选择提供一些参考。

1  临床资料

本组共95例患者，男性22例，女性73例;年龄15～42岁，平均23.5岁，67例患者直系亲属中有腋臭发生。所有患者无手术外伤史，腋下淋巴结无肿大，皮肤无红肿疼痛，血常规及凝血功能正常。按照不同手术方法分为负压抽吸联合搔刮组（55例，110侧）和小切口皮下剪除组（40例，80侧）。

2  治疗方法

2.1 负压抽吸联合搔刮组：患者仰卧，双手抱头。备皮刀刮除腋毛，术区常规消毒铺巾，亚甲蓝标记手术范围为腋毛边缘外1cm，沿上臂腋毛远端设计5mm长的横向手术切口。250ml生理盐水+2%利多卡因20ml+肾上腺素0.25mg行肿胀麻醉，每侧约100ml，肿胀麻醉层次位于皮下与浅筋膜层。用长的钝头组织剪沿皮下脂肪浅层分离，用前端呈锯齿样腋臭抽吸搔刮器接100kPa负压行皮下汗腺搔刮抽吸（见图1～2），搔刮器的吸引孔朝外，先沿腋毛纵轴扇行抽吸，然后沿腋毛横轴行渐进横向抽吸。搔刮至皮肤厚度2～3mm，厚度相当于全厚皮。生理盐水行皮下冲洗后挤出冲洗液，缝合1针，不打结，待第2天皮下渗液充分引流后打结关闭伤口。术后无菌敷料覆盖，并用笔者科室特制腋臭包扎袖带固定（见图3），术后7d拆线。