CN105232140A - Nm汗腺定位消融术 - Google Patents
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Abstract
本发明公开了NM汗腺定位消融术,NM汗腺定位消融术适用于腋部异味、腋部多汗及腋部多毛症,该定位消融术的操作步骤如下:1)麻醉剂的配制;2)做局部麻醉;3)手术操作;4)术后的处理。相较于药物、微创及传统手术方法,NM汗腺定位消融术具有根治效果确切、切口隐蔽、创伤小等优点是一种值得推广的好方法。
Description
技术领域
本发明属于医疗技术领域,尤其涉及NM汗腺定位消融术
背景技术
腋臭是由于腋部大汗腺与微生物相互作用后产生的气味。虽不对机体造成直接伤害,但是给患者社会生活带来不便,导致不同程度的心里负担及障碍。现有的治疗方法一般采用药物、微创及传统手术方法,但根治效果不好、切口较大、创伤大等缺点。
发明内容
本发明的目的在于提供NM汗腺定位消融术,以解决上述技术问题。
为实现上述目的本发明采用以下技术方案:
NM汗腺定位消融术适用于腋部异味、腋部多汗及腋部多毛症,该定位消融术的操作步骤如下:
1)麻醉剂的配制
以2%利多卡因和肾上腺素(1-滴/支)和0.9%氯化钠配制成60-100ml肿胀麻醉液;
2)做局部麻醉
麻醉范围应超出腋毛边缘4cm为宜,麻醉液量应视个体情况而定,但不应少于60ml,药液注射后术区皮肤应明显隆起,高于正常皮肤表面约0.5cm;
3)手术操作
当前主要切口分别为腋横纹切口及腋后线切口;沿皮下0.2-0.5cm大汗腺下缘与脂肪层交界处,以止血钳、组织剪做钝性及锐性分离至腋毛边缘2.0-2.5cm处,去除大汗腺时见皮下呈乳白色、大量大小相同白色颗粒状组织、网状层血管及腋毛毛囊时即可停止修剪,此层即为真皮层其内含有较大的血管淋巴管以及汗腺、毛囊,皮脂腺;无需刻意去除皮下血管网及皮脂腺毛囊复合体。如继续修剪即会损伤真皮层及血光网,导致皮瓣坏死、切口延迟愈合、溃疡形成及瘢痕增生挛缩;冲洗:以庆大霉素+0.9%氯化钠冲洗术区,采用双击电凝止血,如无双极时止血方式以结扎止血为宜,应减少缝扎;缝合及皮瓣固定:①缝合:应以“000”不可吸收线缝合不应以减少缝针数量为目的,而应以皮缘尽量对合为主且缝合张力不易过大。②皮瓣缝合固定:因部分患者皮肤松弛或身材消瘦腋窝凹陷明显及年轻患者术后制动较差,上肢用力活动等均可导致片不能很好的紧贴创面基底,形成死腔及血肿,故此类患者需皮瓣缝合固定,皮肤松弛及年轻术后制动较差者,于术区边缘固定4-6针。腋窝凹陷明显者,于腋窝最深处固定1-2针,上述缝合固定张力均不可过大,缝合固定线可于术后5天内拆出;无菌纱布包扎覆盖范围应超出术区边缘3cm为宜且填塞纱布应尽量松软,包扎敷料厚度6-8cm为宜,使腋窝及敷料形成一圆柱形,绷带固定应包绕整个肩关节,两端应分别超过肩关节上下缘5cm,松紧度以可插入1根手指为宜。包扎结束后应观察上肢末梢血运20-30min;
4)术后的处理
①、给予抗生素口服1-3天;②、据患者个体情况可适当给予止血药治疗1-2次;③、术后即可给予红光、电磁波等物理照射治疗加速血液循环,淤血吸收,减轻细胞水肿促进创面愈合,必要时可根据患者个体及皮瓣血运情况可适当给予活血化瘀药物;④、术后前3-4日来院复诊并换药;⑤、术后加强宣教工作,嘱患者加强全身营养并保证患者上肢制动及防止自行拆出绷带;⑥、待绷带拆出后24小时应逐渐恢复上肢活动及加强外展、上举功能2-3月,防止挛缩;⑦、如无意外则可于8-9天拆出缝合线;⑧、待皮瓣切口完全愈合后给予防瘢痕治疗6-8月;⑨、一月内避免抬、举重物及高强度体育活动。
本发明的有益效果:相较于药物、微创及传统手术方法,NM汗腺定位消融术具有根治效果确切、切口隐蔽、创伤小等优点是一种值得推广的好方法。
具体实施方式
NM汗腺定位消融术适用于腋部异味、腋部多汗及腋部多毛症,该定位消融术的操作步骤如下:
1)麻醉剂的配制
以2%利多卡因+肾上腺素(1-滴/支)+0.9%氯化钠配制成60-100ml肿胀麻醉液做局部麻醉。
2)做局部麻醉
麻醉范围:因皮下大汗腺分布面积大于腋毛边缘0.5-1.0cm,故麻醉范围应超出腋毛边缘4cm为宜。麻醉液量应视个体情况而定,但不应少于60ml。药液注射后术区皮肤应明显隆起,高于正常皮肤表面约0.5cm。因腋窝为躯干及上肢连接部,其内含大量血管、神经及淋巴分布,但缺少脂肪等结缔组织覆盖。故以大量肿胀麻醉液注射后可使组织水肿明显、层次清楚便于分离。使小血管管径缩小及部分闭合,减少术中出血及避免损伤深部重要组织。
3)手术操作
A、切口选择:当前主要切口分别为腋横纹切口及腋后线切口。理论上腋横纹切口,利用正常皮肤生理皱褶,缝合时皮肤张力较低,易于切口对合,瘢痕增生较轻愈后更为美观且无论术区面积大小其操作较为方便。但实际操作中两者术后均有切口坏死、延迟愈合及瘢痕增生明显等情况发生。单以操作而言横纹较后线具有优势。
B、手术范围:沿皮下0.2-0.5cm大汗腺下缘与脂肪层交界处,以止血钳、组织剪做钝性及锐性分离至腋毛边缘2.0-2.5cm处,便于翻转皮瓣暴露大汗腺。(大汗腺呈暗黑色、红褐色及黄褐色三种。前两者与脂肪组织区别明显。黄褐色大汗腺与脂肪组织虽颜色差别不大易于混淆,从其形态大小、质地、色泽及分布范围仍可鉴别。脂肪组织颗粒明显大于大汗腺、质地较于大汗腺柔软、色泽明显亮于大汗腺且范围分布于大汗腺之外。)分离大汗腺时应尽量保留下端脂肪组织。
C、修剪层次:去除大汗腺时见皮下呈乳白色、大量大小相同白色颗粒状组织、网状层血管及腋毛毛囊时即可停止修剪,此层即为真皮层其内含有较大的血管淋巴管以及汗腺、毛囊,皮脂腺等。无需刻意去除皮下血管网及皮脂腺毛囊复合体。如继续修剪即会损伤真皮层及血光网,导致皮瓣坏死、切口延迟愈合、溃疡形成及瘢痕增生挛缩。(若需去除腋毛应改用精细眼科组织剪,剪除毛囊并将腋毛剔除。)
D、冲洗:以庆大霉素+0.9%氯化钠冲洗术区,可避免大汗腺残留、预防感染、减少皮下血块粘附影响贴合及观察有无进行出血。(进行性出血时冲洗液呈鲜红或暗红色,如无则为淡红色。)
E、止血:出血点多见于腋窝动、静脉小分支走行处,位置主要分布于术区1、2象限。可采用双击电凝止血,如无双极时止血方式以结扎止血为宜,应减少缝扎。因腋窝神经末梢丰富,缝扎易牵拉周围正常组织神经末梢,导致术后牵拉性疼痛及不适。如无明显出血点可选用冰盐水及肾上腺素溶液冲洗收缩毛细血管止血。
F、缝合及皮瓣固定:①缝合:应以“000”不可吸收线(术后切口缺血缺氧明显,可吸收线将会加剧愈合负担,易导致切口坏死、延迟愈合及瘢痕增生明显)缝合不应以减少缝针数量为目的,而应以皮缘尽量对合为主且缝合张力不易过大。(张力过大易导致皮瓣撕豁影响愈后)。②皮瓣缝合固定:因部分患者皮肤松弛或身材消瘦腋窝凹陷明显及年轻患者术后制动较差,上肢用力活动等均可导致片不能很好的紧贴创面基底,形成死腔及血肿,故此类患者需皮瓣缝合固定。皮肤松弛及年轻术后制动较差者,于术区边缘固定4-6针。腋窝凹陷明显者,于腋窝最深处固定1-2针。上述缝合固定张力均不可过大。缝合固定线可于术后5天内拆出。
G、包扎固定:包扎主要目的为保护术区防止创面感染、限制肢体活动避免出血、压迫止血防止血肿形成、为皮瓣贴合创造有利环境。故无菌纱布包扎覆盖范围应超出术区边缘3cm为宜且填塞纱布应尽量松软,避免多次折叠过硬纱布挫伤皮肤。包扎敷料厚度6-8cm为宜,使腋窝及敷料形成一圆柱形,以便于绷带加压固定。绷带固定应包绕整个肩关节,两端应分别超过肩关节上下缘5cm,松紧度以可插入1根手指为宜。包扎结束后应观察上肢末梢血运20-30min,避免压力过高导致皮瓣缺血性坏死及骨筋膜室综合症发生。
4)术后的处理
①、给予抗生素口服1-3天;②、据患者个体情况可适当给予止血药治疗1-2次(月经期禁用,具体见相关药物说明书);③、术后即可给予红光、电磁波等物理照射治疗加速血液循环,淤血吸收,减轻细胞水肿促进创面愈合,必要时可根据患者个体及皮瓣血运情况可适当给予活血化瘀药物(月经期慎用、孕妇忌用,详见相关药物说明书);④、术后前3-4日来院复诊并换药;⑤、术后加强宣教工作,嘱患者加强全身营养并保证患者上肢制动及防止自行拆出绷带;⑥、待绷带拆出后24小时应逐渐恢复上肢活动及加强外展、上举功能2-3月,防止挛缩;⑦、如无意外则可于8-9天拆出缝合线;⑧、待皮瓣切口完全愈合后给予防瘢痕治疗6-8月;⑨、一月内避免抬、举重物及高强度体育活动(如篮球、羽毛球及游泳等)。
疾病原理:腋臭是由于腋部大汗腺与微生物相互作用后产生的气味。虽不对机体造成直接伤害,但是给患者社会生活带来不便,导致不同程度的心里负担及障碍。
禁忌症:严重精神异常、心理障碍、重要脏器功能不全、严重血液病、全身性或手术部位感染、严重高血压、心脑血管疾病和肝肾功能疾病使用抗凝药物、大剂量激素等药物。
显然,以上所描述的实施例仅仅是本发明一部分实施例,而不是全部的实施例。基于本发明中的实施例,本领域普通技术人员在没有做出创造性劳动前提下所获得的所有其他实施例,都属于本发明保护的范围。
Claims (1)
1.NM汗腺定位消融术,其特征在于,NM汗腺定位消融术适用于腋部异味、腋部多汗及腋部多毛症,该定位消融术的操作步骤如下:
1)麻醉剂的配制
以2%利多卡因和肾上腺素(1-滴/支)和0.9%氯化钠配制成60-100ml肿胀麻醉液;
2)做局部麻醉
麻醉范围应超出腋毛边缘4cm为宜,麻醉液量应视个体情况而定,但不应少于60ml,药液注射后术区皮肤应明显隆起,高于正常皮肤表面约0.5cm;
3)手术操作
当前主要切口分别为腋横纹切口及腋后线切口;沿皮下0.2-0.5cm大汗腺下缘与脂肪层交界处,以止血钳、组织剪做钝性及锐性分离至腋毛边缘2.0-2.5cm处,去除大汗腺时见皮下呈乳白色、大量大小相同白色颗粒状组织、网状层血管及腋毛毛囊时即可停止修剪,此层即为真皮层其内含有较大的血管淋巴管以及汗腺、毛囊,皮脂腺;无需刻意去除皮下血管网及皮脂腺毛囊复合体。如继续修剪即会损伤真皮层及血光网,导致皮瓣坏死、切口延迟愈合、溃疡形成及瘢痕增生挛缩;冲洗:以庆大霉素+0.9%氯化钠冲洗术区,采用双击电凝止血,如无双极时止血方式以结扎止血为宜,应减少缝扎;缝合及皮瓣固定:①缝合:应以“000”不可吸收线缝合不应以减少缝针数量为目的,而应以皮缘尽量对合为主且缝合张力不易过大。②皮瓣缝合固定:因部分患者皮肤松弛或身材消瘦腋窝凹陷明显及年轻患者术后制动较差,上肢用力活动等均可导致片不能很好的紧贴创面基底,形成死腔及血肿,故此类患者需皮瓣缝合固定,皮肤松弛及年轻术后制动较差者,于术区边缘固定4-6针。腋窝凹陷明显者,于腋窝最深处固定1-2针,上述缝合固定张力均不可过大,缝合固定线可于术后5天内拆出;无菌纱布包扎覆盖范围应超出术区边缘3cm为宜且填塞纱布应尽量松软,包扎敷料厚度6-8cm为宜,使腋窝及敷料形成一圆柱形,绷带固定应包绕整个肩关节,两端应分别超过肩关节上下缘5cm,松紧度以可插入1根手指为宜。包扎结束后应观察上肢末梢血运20-30min;
4)术后的处理
①、给予抗生素口服1-3天;②、据患者个体情况可适当给予止血药治疗1-2次;③、术后即可给予红光、电磁波等物理照射治疗加速血液循环,淤血吸收,减轻细胞水肿促进创面愈合,必要时可根据患者个体及皮瓣血运情况可适当给予活血化瘀药物;④、术后前3-4日来院复诊并换药;⑤、术后加强宣教工作,嘱患者加强全身营养并保证患者上肢制动及防止自行拆出绷带;⑥、待绷带拆出后24小时应逐渐恢复上肢活动及加强外展、上举功能2-3月,防止挛缩;⑦、如无意外则可于8-9天拆出缝合线;⑧、待皮瓣切口完全愈合后给予防瘢痕治疗6-8月;⑨、一月内避免抬、举重物及高强度体育活动。
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