腋窝顶泌汗腺的应用解剖与组织病理学观察

摘要

目的 研究腋臭顶泌汗腺的分布范围与层次,为治疗腋臭提供应用解剖与病理学依据.方法 对2具腋臭,8具非腋臭10%甲醛固定成人尸体,进行腋窝应用解剖;对25例重度腋臭患者予以顶泌汗腺去除手术的组织病理学观察.结果 顶泌汗腺分泌部肉眼清晰可见,呈粟粒样颗粒;尸体上呈黑褐色,活体上为粉红色;主要分布在腋毛区域内,可超过腋毛区域外,但未超过1.0 cm;以腋窝中央横皱襞处最为密集,外围呈散在分布.顶泌汗腺分泌部位于真皮网状层与腋浅筋膜之间的浅层脂肪组织内,在真皮网状层下方已移行为导管部.在靠近真皮网状层处,其被结缔组织缠绕,形成完整、坚韧、不易刮除的膜状结构;在下方与腋浅筋膜连接紧密,不易分离.真皮面上白色突起颗粒为皮脂腺毛囊复合体.结论 直视下去除真皮下粉红色粟粒样组织和腋浅筋膜,干净去除顶泌汗腺分泌部;结合紧贴真皮面剪除毛囊处理导管部,可根治腋臭.手术范围不可过宽,以腋毛区域外1.0 cm为宜.%Objective To investigate the distribution range and depth of the apocrine sweat glands of the axillary fossa,in order to supply with anatomic and histopathologic basis in the treatment on axillarv osmidrosis.Methods From December 2008 to ()ctober 2010,2 biopsy samples(with axillary osmidrosis),8 biopsy samples(normal,without axillary osmidrosis),were employed into the axillarv anatomy study. 25 patients with severe axillary osmidrosis were observed both maerographicallv and microscopically by using of operation and histopathological methods.Results Secretory portion of apocrine sweat glands was seen clearly,it was pitchy millet-like granules on axillary osmidrosis corpse,and pink millet-like granules in vivo.Secretory portions distributed most within the armpit hair area,exceeded the edge of armpit hair line,but not surpassed the edge of armpit hair line 1.0 cm.The depth of the apocrine sweat glands located vertically at superficial fat tissues between the dermal reticular 1aver and superficial fascia layers which were dissected away easily.Trimming with scissors under dermaIlayer,the secretory portion of apocrine sweat glands was removed cleanly without harms to reticular laver of dermas.Secretory portions became ducts under reticular layer of dermas.White Drominence-like granules were proved to be the compomers of hair follicle and sebaceous glands through Dathological section.Conclusions In order to treat axillary osmidrosis effectively,the secretary portion should be removed away through cutting off the tissues between the dermal reticular layer and suDerficial fastia layers;the ducts of apocrine sweat glands should be handled with removing hair follicle under the reticular layer of dermas．0peration area should not exceed 1.0 cm off the edge.