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[Antral type Borrmann type IV (2) - A typical case]

2020-8-10. 8PM. EndoTODAY Live

* Âü°í: In depth analysis º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï À§³»½Ã°æ ¾ÆƲ¶ó½º (PDF) 2024

Á߳⠳²¼ºÀ¸·Î ÀüÁ¤ºÎ¿¡ ±¹ÇÑµÈ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀÔ´Ï´Ù. Á¶Á÷°Ë»ç¿¡´Â ¾ÏÀ¸·Î ³ª¿ÀÁö ¾Ê¾ÒÁö¸¸ gastric outlet obstructionÀÇ ÀÓ»óÁõ»óÀ» °¡Áö°í ÀÖ¾ú½À´Ï´Ù.

CT¿¡¼­µµ ÀüÁ¤ºÎ¿¡ ±¹ÇÑµÈ º¸¸¸ 4Çü¿¡ ÇÕ´çÇÑ ¼Ò°ßÀÌ ÀÖ¾ú½À´Ï´Ù. Á¦°¡ º°·Î ÁÁ¾ÆÇÏ´Â °Ë»ç´Â ¾Æ´Õ´Ï´Ù¸¸, EUS¿¡¼­µµ wall thickeningÀÌ ÀÖ¾ú½À´Ï´Ù.

Exploratory laparotomy¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù. ¾Æ½±°Ôµµ peritoneum¿¡ metastatic noduleµéÀÌ scattered µÇ¾î ÀÖ¾ú°í frozen¿¡¼­ metastatic adenocarcinoma°¡ ³ª¿Ô½À´Ï´Ù.

ÀüÁ¤ºÎ¿¡ ±¹ÇÑµÈ º¸¸¸ 4Çü Áß ÀÌó·³ mucosal lesionÀÌ ¾ø´Â °æ¿ì´Â ¾ÏÀ» ÀǽÉÇϱ⠾î·Æ½À´Ï´Ù. ¼³È¤ ¾ÏÀ» ÀǽÉÇÏ¿´´Ù°í ÇÏ´õ¶óµµ Á¶Á÷°Ë»ç·Î ¾ÏÀÌ È®ÁøµÇÁö ¸øÇÏ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù.ÀüÁ¤ºÎ¿¡ ±¹ÇÑµÈ º¸¸¸ 4Çü ÁøÇ༺À§¾ÏÀ̶ó´Â º´ÀÌ ÀÖ´Ù´Â °ÍÀ» ¾Ë¾Æ¾ß¸¸ ÀǽÉÇÏ°í Ä¡·áÇÒ ¼ö ÀÖ´Â »óȲÀÔ´Ï´Ù. ¾ÏÀÌ ÀǽɵǸé Áöü¾øÀÌ exploratory laparotomy¸¦ ½ÃÇàÇØ¾ß ÇÕ´Ï´Ù. ±×·¡µµ curative resectionÀ» ÇÒ ¼ö ÀÖ´Â °æ¿ì°¡ ¸¹Áö ¾Ê½À´Ï´Ù.

ÁÖÀÇÇØ¾ß ÇÒ Á¡Àº obstruction Áõ»óÀÌ ¹ß»ýÇϱâ Àü¿¡´Â ³»½Ã°æ¿¡¼­ ¾ÏÀ» ÀǽÉÇϱ⠾î·Æ´Ù´Â Á¡ÀÔ´Ï´Ù. ³»½Ã°æ °Ë»ç¸¦ ¹Þ°í ¾ó¸¶ µÇÁö ¾ÊÀº ȯÀÚ¿¡¼­ ¹ß°ßµÇ´Â AGCÀÇ ¿øÀÎ Áß Çϳª°¡ ÀüÁ¤ºÎ¿¡ ±¹ÇÑµÈ º¸¸¸ 4Çü ÁøÇ༺À§¾ÏÀ̶ó´Â Á¡À» ÀØÁö ¸¶½Ê½Ã¿À.


[Quiz]

º¹ºÎ ºÒÆí°¨°ú üÁß°¨¼Ò·Î ³»¿øÇÑ 20´ë ¿©¼ºÀÇ À§³»½Ã°æ¿¡¼­ ¾Æ·¡¿Í °°Àº ¼Ò°ßÀÌ º¸ÀÌ¸é ¹«½¼ Áúº´À» »ý°¢ÇØ¾ß ÇÒ±î¿ä?

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Antral type º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀÔ´Ï´Ù. ¹°·Ð duodenal ulcer stricture¿¡¼­µµ gastric outlet obstructionÀÌ °¡´ÉÇÕ´Ï´Ù¸¸, ¿äÁòÀº º¸¸¸ 4Çü À§¾ÏÀ» ´õ ÀÚÁÖ º¸´Â °Í °°½À´Ï´Ù. ¹°·Ð »ó±ÞÁ¾ÇÕº´¿ø¿¡¼­ °¡Áú ¼ö ÀÖ´Â biasÀÏ ¼öµµ ÀÖÁö¸¸...

(2013)

ÀüÁ¤ºÎ º®ÀÌ ÀüüÀûÀ¸·Î µÎ²¨¿öÁ³°í ÆìÁöÁö ¾ÊÀ¸¸é¼­ ½ÊÀÌÁöÀå ÀϺαîÁö ħÀ±µÇ¾î ÀÖ½À´Ï´Ù. ¼Ò¸¸ÂÊÀ» µû¶ó¼­´Â À§Ã¼ÁߺαîÁö ħ¹üµÇ¾î ÀÖ½À´Ï´Ù. ´ë¸¸ Èĺ®ÂÊÀ¸·Î ÀÛÀº ÇÔ¸ôºÎ°¡ ÀÖÁö¸¸, ÀüüÀûÀ¸·Î´Â antral type º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀÔ´Ï´Ù.


[Gastric outlet obstruction due to peptic ulcer]

¼ÒÈ­¼º ±Ë¾çÀÌ ¹Ýº¹µÇ¸é¼­ gastric outlet obstructionÀÌ µÇ¸é antral type º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï°ú ±¸ºÐÀÌ ¾î·Á¿ï ¼ö ÀÖ½À´Ï´Ù.

30´ë ³²ÀÚ. 3°³¿ù ÀüºÎÅÍ ¹ß»ýÇÑ º¹Åë°ú ±¸Åä·Î ³»¿øÇÏ¼Ì°í ¿©·¯¹ø Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾ÒÀ½. ¼ö¼úÀ» ÇÏ¿´À½. Antrectomy with truncal vagotomy¸¦ ÇÏ¿´°í ÀýÁ¦ÇÑ Ç¥º»¿¡¼­µµ peptic ulcer with inflammed granulation tissue·Î¸¸ ³ª¿Ô°í ¾Ï ¼Ò°ßÀº ¾ø¾úÀ½.


[FAQ]

[2018-7-17. ¾Öµ¶ÀÚ Áú¹®]

°ËÁø À§³»½Ã°æ¿¡¼­ À§°¢ºÎ ÁøÇ༺ À§¾ÏÀ¸·Î ÀÇ·ÚµÈ 40´ë ÈÄ¹Ý ¿©¼º ȯÀÚÀÔ´Ï´Ù. ¿ÜºÎ »çÁøÀ» º¸¸é ºñ±³Àû ÀþÀº ȯÀÚÀÇ ³»½Ã°æÀε¥µµ À½½Ä¹°ÀÌ ³²¾ÆÀÖÀ¸¸ç, À§°¢ºÎ ±Ë¾ç, ÀüÁ¤ºÎÀÇ abnormal fold thickening ¹× luminal narrowing ¼Ò°ßÀ¸·Î º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ» ½Ã»çÇÏ´Â ¼Ò°ßÀ̾ú½À´Ï´Ù.

À§°¢ºÎ¿¡ ±Ë¾çÀÌ ÀÖÀ¸³ª retroflexion view¿¡¼­ cardia°¡ Á¶±Ý °¡±î¿öº¸¿´°í, °¡±õ°Ô´Â lower body, ¸Ö°Ô´Â midbody±îÁö ¾Ï ħÀ±ÀÌ ÀÖÀ» °ÍÀ¸·Î ÆǴܵǾú½À´Ï´Ù. Pyloric ringÀº Á¼¾ÆÁ® ÀÖÀ¸³ª Åë°ú´Â °¡´ÉÇÏ¿´°í, ½ÊÀÌÁöÀå ±¸ºÎ±îÁö ħ¹üµÈ ¼Ò°ßÀ̾ú½À´Ï´Ù. ¿ÜºÎ Á¶Á÷°Ë»ç¿¡¼­´Â À§°¢ºÎ ±Ë¾ç¿¡¼­´Â ¾ÏÀ¸·Î ³ª¿ÔÀ¸³ª ÀüÁ¤ºÎ Á¶Á÷°Ë»ç¿¡¼­´Â ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾Ò½À´Ï´Ù.

ÀÇ·Ú ÈÄ º» º´¿ø¿¡¼­ Àç°Ë(ù °Ë»ç 10ÀÏ ÈÄ)À» ÇÏ¿´°í ´ëºÎºÐ ¼Ò°ßÀº ºñ½ÁÇßÁö¸¸ pyloric ringÀ» Åë°úÇÒ ¼ö ¾ø¾ú½À´Ï´Ù. À½½Ä¹°·Î ÀÎÇÏ¿© À§Ã¼»óºÎ ´ë¸¸ ¹× ±âÀúºÎ¸¦ È®ÀÎÇϱ⠾î·Á¿üÀ¸³ª ¿ÜºÎ »çÁøÀ» Âü°íÇØ ÀÌ ºÎÀ§´Â sparing µÈ °ÍÀ¸·Î ÆÇ´ÜÇÏ¿© antral typeÀÇ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ¸·Î impressionÀ» Àâ¾Ò½À´Ï´Ù.

ÃÖÁ¾ pathology´Â T4aN2 AGC (Middle third and lower third, Center at antrum and lesser curvature, Borrmann type 4, tubular adenocarcinoma, poorly (poorly cohesive) differentiated, 9x7 cm, invades serosa, free resection margin, pN2)¿´½À´Ï´Ù.

¿¹»ó´ë·Î MB±îÁö involve°¡ µÈ ¾ÏÀ̾úÀ¸³ª ¹®µæ ÀÌ°ÍÀÌ antral type B-IVÀÇ Á¤ÀÇ¿¡ ¸Â´Â °ÍÀÎÁö ±Ã±ÝÇÏ¿´½À´Ï´Ù. Antral typeÀº ¹®ÀÚ ±×´ë·Î antrum¿¡¸¸ ±¹ÇѵǾî¾ß ºÙÀÏ ¼ö ÀÖ´ÂÁö, ¾Æ´Ï¸é B-IV Ư¼º»ó ÁÖÀ§·Î spreadingÀÌ °¡´ÉÇϱ⠶§¹®¿¡ ÀÌ Áõ·Êó·³ epicenter°¡ antrumÀ̸é ÃæºÐÇÑÁö ¹®Àǵ帳´Ï´Ù.

[2018-7-19. ÀÌÁØÇà ´äº¯ Áú¹®]

ÁøÇ༺ À§¾ÏÀº º¸¸¸ ºÐ·ù°¡ Àû¿ëµË´Ï´Ù. º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ» subtypeÀ¸·Î ³ª´©±âµµ ÇÏÁö¸¸ ÇÕÀÇµÈ Á¤ÀÇ°¡ ÀÖ´Â °ÍÀº ¾Æ´Õ´Ï´Ù. ¿©·¯ ÀڷḦ ´Ù½Ã »ìÆ캸¾Ò½À´Ï´Ù¸¸, Á¤Çö¿ë ±³¼ö´Ô²²¼­ ³»½Ã°æ ¼¼¹Ì³ª °­ÀÇ·Ï¿¡ ¿ä¾àÇØ ³õÀº °ÍÀÌ °¡Àå ÀϹÝÀûÀÎ ³»¿ë °°½À´Ï´Ù. Á¤±³¼ö´Ô²²¼­´Â 'À¯¹® ÇùÂøÇü'°ú '±¤¹üÀ§ ħÀ±Çü'À» ¾ð±ÞÇÏ°í °è½Ê´Ï´Ù. ÀÌÁß 'À¯¹® ÇùÂøÇü'ÀÌ Á¦°¡ 2013³â 2¿ù 24ÀÏ EndoTODAY¸¦ ÅëÇÏ¿© ¼Ò°³ÇÑ antral type º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï°ú °°´Ù°í »ý°¢µË´Ï´Ù.

45ȸ ³»½Ã°æ ¼¼¹Ì³ª. Á¤Çö¿ë (PDF)

2016³â Clin Endosc¿¡ ¹Ú¹«ÀÎ ±³¼ö´Ô²²¼­ ±â°íÇÑ ³í¹®(Borrmann Type 4 Advanced Gastric Cancer: Focus on the Development of Scirrhous Gastric Cancer)¿¡´Â ¾Æ·¡¿Í °°Àº ±×¸²ÀÌ ÀÖ½À´Ï´Ù. ÁÂÃø ¾Æ·¡ÀÇ 'Borrmann type 4 AGC: diffuse, common in antrum and pylorus' ¶ó°í ¼³¸íµÈ ºÎºÐÀÔ´Ï´Ù. ÀϺ»¿¡¼­´Â Borrmann type 4¶ó°í ºÎ¸£¸é ÁÖ·Î antral typeÀ» ¸»ÇÏ´Â ¸ð¾çÀÔ´Ï´Ù. ¿ì¸®°¡ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ̶ó°í ºÎ¸£´Â À§Ã¼ºÎ¿Í fundusÀÇ diffuseÇÑ º´¼Ò¿¡ ´ëÇÏ¿© ÀϺ»¿¡¼­´Â linitis plastica³ª schirrhous gastric cancer¶ó´Â ¿ë¾î¸¦ »ç¿ëÇÏ°í ÀÖ¾î ´Ù¼Ò È¥¶õ½º·´½À´Ï´Ù.

Àú´Â º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï¿¡ ´ëÇÑ ÀϺ»½Ä ¿ë¾î(linitis plastica, schirrhous gastric cancerµî)´Â ÇÇÇÏ´Â °ÍÀÌ ÁÁ°Ú´Ù°í »ý°¢ÇÕ´Ï´Ù. ±×³É ¸ðµÎ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ¸·Î ºÎ¸£´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. ´Ù¸¸ ÀüÁ¤ºÎ¿¡ ±¹ÇÑµÈ ¼Ò¼öÀÇ Æ¯¼öÇÑ °æ¿ì¸¦ antral typeÀ̶ó°í µû·Î ¸í¸íÇÏÀÚ´Â °ÍÀÌ ÀúÀÇ Á¦¾ÈÀÔ´Ï´Ù. Áï antral typeÀº 'º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï'ÀÇ ºÎºÐÁýÇÕÀÎ °ÍÀÎÁö¿ä.

Á¦°¡ antral typeÀ» Ưº°È÷ µû·Î ¾ð±ÞÇÏ´Â °ÍÀº ¹«½¼ ÀÌÀ¯Àϱî¿ä? Antral typeÀ̶ó´Â °ÍÀ» ¸ð¸£°í ÀÖÀ¸¸é Áø´ÜÀ» ¸øÇÏ´Â °æ¿ì°¡ ¹ß»ýÇϱ⠶§¹®ÀÔ´Ï´Ù.

EndoTODAY 2013-2-26 ³»½Ã°æ °Ë»ç¿¡¼­ miss ÇÏ¿´´ø antral type B-IV

±×·¸´Ù¸é ¾î¶² °æ¿ì¸¦ antral typeÀ̶ó°í ºÎ¸£´Â °ÍÀÌ ÁÁÀ»±î¿ä? Antrum°ú pyloric ring¿¡ ±¹ÇÑµÈ °æ¿ì¸¸À» antral typeÀ¸·Î ºÎ¸£´Â °ÍÀÌ ÁÁÀ»Áö, Á» ´õ ³Ð´õ¶óµµ epicenter°¡ antrumÀÌ¸é ¸ðµÎ antral typeÀ¸·Î ºÎ¸¦Áö °í¹ÎÀÌ ¾Æ´Ò ¼ö ¾ø½À´Ï´Ù. Àú´Â ÀÌ´ë º´¿øÀÇ 2015³â ³í¹®ÀÇ ¾Æ·¡ tableÀ» ¼Ò°³ÇÏ°í ½Í½À´Ï´Ù. Lower 1/3¿¡ ±¹ÇÑµÈ °æ¿ì°¡ 16/7% ÀÖ¾ú½À´Ï´Ù. Àú´Â À̵鸸À» antral type º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ¸·Î ºÎ¸¦ °ÍÀ» Á¦¾ÈÇÕ´Ï´Ù.

´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸÁö 2015;15:166

ÀÌ·± °üÁ¡¿¡¼­ ¼±»ý´ÔÀÇ Áõ·Ê´Â antral typeÀ̶ó°í ºÎ¸£Áö ¸» °ÍÀ» ±ÇÇÕ´Ï´Ù. ±×³É À§¸¦ °ÅÀÇ involveÇÏ¿© ½ÉÁö¾î pyloric ring±îÁö ħÀ±µÈ ±×³É º¸ÅëÀÇ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ¸·Î »ý°¢ÇÏ¸é ¾î¶³±î¿ä?

¿ä¾àÇÕ´Ï´Ù. º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï Áß ÀüÁ¤ºÎ¿¡ ±¹ÇÑµÈ °æ¿ì¸¸À» antral typeÀ¸·Î ºÎ¸¨½Ã´Ù. Á¡¸· º´¼Ò¿Í ÁÖ¸§ ºñÈÄ ¾øÀÌ ÀüÁ¤ºÎ¿Í ³¯¹®ÀÌ µÎ²¨¿öÁö¸é obstruction Áõ»óÀ» ÀÏÀ¸Å°´Â °ÍÀÌ Æ¯Â¡ÀÔ´Ï´Ù.


[References]

1) EndoTODAY À§¾Ï 642 - Antral type º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï¿¡ ´ëÇÑ Áú¹®°ú ´äº¯

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