以皮下刮除術及抽脂管抽吸法治療腋下臭汗症

Treatment of Axillary Bromidrosis with Subcutaneous Scraping and Superficial Liposuction

黃乾誠(Chane-Chen Hwang)

《北市醫學雜誌》 2卷9期 (2005/09) Pp. 789-794

https://doi.org/10.6200/TCMJ.2005.2.9.03

摘要

目的：腋下臭汗症，它常引起人際及社交上的窘境。外科手術治療，以切除皮下組織或合併切除腋毛區域皮膚，是過去幾十年來治療選擇，但常併發傷口皮膚部分壞死、血腫、不好看的疤痕。以刮除合併抽脂管抽吸法來治療腋下臭汗症，已有零星報告，本研究在探討以刮除及抽脂管抽吸法治療腋下臭汗症的結果，並和其他手術方式的結果做一比較。方法：1996年7月至2002年6月6年間，302位患者（604例病灶）因腋下臭汗症在局部腫脹麻醉下，接受刮除及抽脂管抽吸手術，去除腋下頂漿腺。手術後以紗布棉墊覆蓋壓迫及膠布黏貼一天以上，去除覆蓋物後，即可淋浴，術後七天門診複診追蹤拆線，術後一個月、二個月、三個月及更長時間門診追蹤。結果：302位患者，全部自孩童期就已發現是溼的耳垢，所有的患者都可追蹤到家族史。患者發病年齡自9歲至18歲（平均年齡約13.8歲），手術時的年齡自10歲至55歲（平均年齡33.6歲），追蹤時間自二年至七年（平均5年7個月）。302位患者（604病灶），手術後的結果，有204位極佳，92位屬佳，3位尚可，3位為差。296位患者對手術結果滿意（滿意度98%）。部分患者覺得腋毛有較稀鬆，但沒有除毛的效果。有二病灶(2/604)傷口感染，一病灶有起水泡脫皮現象，並沒有皮瓣壞死，疤痕攣縮或疤痕增生的現象發生。302位患者（604病灶）有292位患者（585病灶）發生短暫性的變硬及凹凸不平，在保守治療後一至二個月，症狀都會緩解。結論：以刮除及抽脂管抽吸法來治療腋下臭汗症，有高成功率及低併發症發生率，術後照顧容易，可避免長期包紮覆蓋或限制兩肩活動，恢復快速，正常的腋毛分佈，不明顯的微小疤痕等優點。此種手術方式也很容易學習，可成為腋下臭汗症的標準治療方式之一。

關鍵字

腋下臭汗症 ； 刮除 ； 表淺抽吸法 ； 多汗症

並列摘要

Background and Purpose: Axillary osmidrosis or bromhidrosis is an embarrassing condition that causes a serious personal handicap, especially in an Asian society. Surgical removal of the subcutaneous tissue, together with axillary hair-bearing skin, has been the treatment of choice in past decades. Complications, such as seroma or hematoma, necrosis of wound edges, unsightly scarring and uneven skin, are problems to overcome in the treatment of axillary osmidrosis. Subdermal scraping and superficial liposuction offer a less invasive treatment. This study presents the results of this treatment. Methods: From July 1996 to June 2002, 302 patients were enrolled in the study (124 men and 178 women). The age of the patients ranged from 10 to 55 years (mean: 33.6 years). These patients underwent subdermal scraping and superficial liposuction for bilateral axillary bromidrosis, under local anesthetic, on an outpatient basis. Postoperative fluffy dressing compression and taping was removed after 36 to 48 hours, by the patients. They were followed up as outpatients at one and two weeks, one and two months, and over one year postoperatively. The follow-up period ranged from two to seven years (mean: five years seven months). Results: Two hundred and ninety six patients (98%) had excellent to good results. Two hundred and ninety six patients (98%) were satisfied with their results. Complications included two lesions with minor infection and one lesion with epidermolysis. Induration and uneven skin over the axillae, seen in most postoperative patients, resolved within two months, after conservative treatment. There were no other significant complications. Conclusions: This minimally- invasive operation has the advantages of a high success rate, low complication rate, tiny or negligible scars, no change in hair distribution pattern, easy postoperative care and a rapid recovery to normal daily activities. We recommend this treatment for axillary bromidrosis.

並列關鍵字

axillary osmidrosis ； bromidrosis ； scraping ； curettage ； superficial liposuction ； hyperhidrosis