摘要目的:比较直视下腋窝皱襞传统小切口会师法与顺小切口法剪除顶泌汗腺治疗腋臭的效果与安全性。方法:采用前瞻性随机对照研究方法，招募2022年6至10月遵义医科大学附属医院美容整形外科收治的腋臭患者。采用随机抽签法将患者分为试验组(采用直视下腋窝皱襞传统小切口会师法剪除顶泌汗腺)和对照组(采用顺小切口方向顶泌汗腺剪除法)。观察2组术后血肿、感染、皮肤坏死、切口延迟愈合、瘢痕及皮肤挛缩等并发症发生情况，计算发生率。术后6个月进行手术效果评价，统计治愈、显效、无效侧数，计算治愈率和有效(治愈＋显效)率；调查满意度情况，分为满意和不满意2个选项，计算满意率。计数资料采用卡方检验进行分析， P<0.05为差异有统计学意义。 结果:共招募52例患者。其中，试验组26例(52侧)，男6例，女20例，年龄18～31岁，平均22岁；对照组26例(52侧)，男6例，女20例，年龄18～47岁，平均21岁。试验组术后并发症发生率为3.85%(2/52)，低于对照组的19.23%(10/52)，差异有统计学意义( χ2＝3.98， P＝0.046)，其中皮瓣坏死、局部挛缩、瘢痕及切口延迟愈合方面试验组均优于对照组。2组的术后有效率均为100%(52/52)，但试验组治愈率高于对照组[96.15%(50/52)vs. 80.77%(42/52)]，差异有统计学意义( χ2＝6.03， P＝0.014)。试验组满意率为96.15%(50/52)，高于对照组的82.69%(43/52)，差异有统计学意义( χ2＝4.92， P＝0.026)。 结论:直视下腋窝皱襞传统小切口会师法剪除顶泌汗腺与传统顺小切口法治疗腋臭比较，前者治愈率更高，能有效保护切口周围皮瓣真皮及真皮下血管网，减少术后皮肤坏死及瘢痕等并发症，提高患者满意率。

abstractsObjective:To compare clinical efficacy and safety of peripheral to central pruning of apocrine sweat glands versus along small incision of apocrine sweat glands in the treatment of axillary bromhidrosis.Methods:A prospective randomized controlled study method was used to recruit patients with armpit odor admitted to the Department of Aesthetic and Plastic Surgery, Affiliated Hospital of Zunyi Medical University from June to October 2022. The patients were divided into the experimental group (underwent peripheral to central pruning of apocrine sweat glands with small incision of axillary fold under direct view) and the control group (apocrine sweat glands were cut off along the direction of small incisions) by randomization. The occurrence of postoperative complications such as hematoma, infection, skin necrosis, delayed incision healing, scar and skin contracture were observed in both groups, and the incidence rate was calculated. The surgical effect was evaluated 6 months after the operation, and the number of cured, markedly effective, and ineffective sides was counted, and the cure rate and effective rate were calculated; the satisfaction was investigated and divided into two options: satisfactory and dissatisfied, and the satisfaction rate was calculated. Count data were analyzed using the chi-square test. P<0.05 indicated that the difference was statistically significant. Results:A total of 52 patients were recruited. Experimental group, 26 patients (52 side), 6 male, 20 women, aged 18-31 years, mean of 22 years; control group, 26 patients (52 side), 6 male, 20 women, aged 18-47 years, mean of 21 years. The incidence of postoperative complications in the experimental group was 3.85% (2 / 52), which was lower than 19.23% (10/52) of the control group, with statistically significant difference ( χ2=3.98, P=0.046), in which the flap necrosis, local contracture, scarring and delayed incision healing were better than the control group. The postoperative response rate in both groups was 100%(52/52), but the cure rate in the experimental group was higher than the control group [96.15% (50/52) vs. 80.77% (42/52)], with a significant difference ( χ2=6.03, P=0.014). The satisfaction rate of the experimental group was 96.15% (50/52), higher than the 82.69% (43/52) of the control group, and the difference was statistically significant ( χ2=4.92, P=0.026). Conclusion:Compared with the traditional small incision of peripheral to central pruning method and the traditional small incision of apocrine sweat glands method, the cure rate of the former is higher, which can effectively protect the skin flap dermis and subdermal vascular network around the incision, reduce postoperative skin necrosis and scar, and improve patient satisfaction.