EndoTODAY | EndoATLAS | Outpatient Clinic

Parasite | Esophagus | Stomach | Cancer | ESD

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1. How I do it in local clinics

1) Core needle biopsy and vacuum assisted biopsy for suspicious breast lesions (µÐ»ê ¼¼ÀÌÀ¯¿Ü°ú À¯±âÀº)

Trucut typeÀÇ core needle biopsyº¸´Ù vacuum assisted biopsyÀÎ mammotomeÀº º¸´Ù Å« °Ëü¸¦ ¾òÀ» ¼ö ÀÖ°í Çѹø¸¸ Â´Ù´Â ÀåÁ¡ÀÌ ÀÖ½À´Ï´Ù.

2) Management of perianal diseases (¼öÁö À¯¿£Ç׿ܰú ÀÌ·çÁö) - »ï¼º¼­¿ïº´¿ø ¿Ü°ú ·¹Áö´øÆ® ¼ö·á ý­ ±¹¸³¾Ï¼¾ÅÍ ´ëÀå¾Ï¼¾ÅÍ ´ëÀå³»½Ã°æ ¾ÆÄ«µ¥¹Ì fellow ý­ »ï¼º¼­¿ïº´¿ø ¿Ü°ú ´ëÀå¾Ï¼¾ÅÍ fellow trainingÀ» ¹ÞÀ¸¼Ì½À´Ï´Ù. ´ëÀåÇ×¹®ÇÐȸ ´ëÀå³»½Ã°æ ¼¼ºÎÀü¹®ÀÇÀ̽ʴϴÙ. ¼öÁö À¯¿£Ç׿ܰú´Â ¿©ÀÚ ¿Ü°ú ÀÇ»ç 3ºÐÀÌ Áø·áÇÏ´Â º´¿øÀÌÁö¸¸, ³²ÀÚ È¯ÀÚµµ 25% Á¤µµ °è½Å´Ù°í ÇÕ´Ï´Ù.

Á÷Àå¼öÁö°Ë»ç ½Ã ȯÀÚ°¡ monitor¸¦ º¼ ¼ö ÀÖ½À´Ï´Ù.

Hemorrhoids are prolapsed anal cushion. Wide excision of hemorrhoids is too radicatl and unnecessary. Anoderm & anal cushion preserving operation is feasible. Lift-up procedure is important to prevent prolapse.

Triamcinolone + lidocaine + indigocarmine + N/S subcutanesou injectionÀ» »ç¿ëÇϱ⵵ ÇÕ´Ï´Ù.

Ä¡·á ÈÄ Àç¹ßÀÌ ¸¹¾Æ¼­ °¡´Ù½Ç µî ¿¹¹æÁֻ縦 ±ÇÇÏ°í ÀÖ½À´Ï´Ù.

3) Single port laparoscopic inguinal hernia repair. ¹¦±âÀΰ¡? ¼ú±âÀΰ¡? (ÇѼֺ´¿ø ÀÌ°üö) - '¹¦±âÀΰ¡? ¼ú±âÀΰ¡?'¶ó´Â ºÎÁ¦°¡ ÀλóÀûÀ̾ú½À´Ï´Ù.

¸Õ °ú°Å¿¡´Â ¹Ù±ùÂÊ¿¡¼­ Á¢±ÙÇÏ¿´Áö¸¸ ÀÌÈÄ º¹°­°æÀ» ÀÌ¿ëÇÏ¿© ¾ÈÂÊ¿¡¼­ Á¢±ÙÇÒ ¼ö ÀÖ°Ô µÇ¾ú°í ÃÖ±Ù¿¡´Â intraperitoneal approach (º¹¸· ¿Ü Á¢±Ù¹ý)°¡ °¡´ÉÇÕ´Ï´Ù.

"º¹°­°æÀ» ÀÌ¿ëÇÑ º¹¸· ¿Ü Á¢±Ù¹ýÀº º¹°­ ³» Á¢±Ù¹ý¿¡ ºñÇØ ¿©·¯ ÀåÁ¡À» °¡Áö°í ÀÖ´Ù. ¸ÕÀú º¹°­ ³»ºÎ·Î Á¢±ÙÇÏÁö ¾Ê±â ¶§¹®¿¡ º¹°­ ¾ÈÀÇ Àå±â ¼Õ»óÀÌ °ÅÀÇ ¾ø´Ù. ¶ÇÇÑ º¹°­ ³» À¯Âø°ú °°Àº ¼ö¼ú ÈÄ ÇÕº´Áõ¿¡ ´ëÇÑ À§Ç輺µµ Àû¾îÁö°Ô µÈ´Ù. º¹¸Á ¾ÈÂÊ¿¡ °ÅÄ¡µÇ´Â Àΰø¸·¿¡ ºñÇØ º¹¸· ¿Ü Á¢±Ù¹ý¿¡ »ç¿ëµÇ´Â Àΰø¸·ÀÇ ºñ¿ëÀÌ Àû¾î ¼ö¼ú ºñ¿ëÀÌ °¨¼ÒÇÏ´Â ÀåÁ¡ÀÌ ÀÖ°Ú´Ù. ±âÁ¸ÀÇ º¹¸· ¿Ü Á¢±Ù¹ýÀº º¸Åë 3°³ÀÇ º¹°­°æ Æ÷Æ®¸¦ ÀÌ¿ëÇÏ¿© Á¢±ÙÇÏ°Ô µÇÁö¸¸ ´ÜÀÏÅë·Î Á¢±Ù¹ý(single port approach)Àº ¹è²Å¿¡ ÇϳªÀÇ Àý°³Ã¢À¸·Î ¼ö¼úÀÌ ÁøÇàµÇ±â¿¡... "


2. ¿Ü°ú Àǻ縦 À§ÇÑ ³»½Ã°æ ±âÃÊ (À¯¾ØÇ׿ܰú ±èÁöÀº)

±èÁöÀº ¼±»ý´ÔÀº ³»½Ã°æ ±âÃÊ anatomy¿Í »çÁø º¸´Â ¹ý µî¿¡ ´ëÇÏ¿© Àß ¼³¸íÇØ Áּ̽À´Ï´Ù.

Àú´Â ¾Æ·¡¿Í °°Àº comment¸¦ Çß½À´Ï´Ù.

"°ú°Åº¸´Ù ³»½Ã°æ ¹è¿ì±â°¡ ¾î·Á¿î ȯ°æÀÔ´Ï´Ù. ±â±¸¿Í ½Ã¼ú¹ýÀÌ º¹ÀâÇØÁø Á¡µµ ÀÖÀ¸³ª, ±×º¸´Ù´Â ¼÷·ÃµÇÁö ¾ÊÀº Àǻ簡 Á÷Á¢ ³»½Ã°æÀ» ½Ã¼úÇϱ⠾î·Á¿öÁ³±â ¶§¹®ÀÔ´Ï´Ù. ȯÀÚÀÇ ¾ÈÀü°ú ȯÀÚÀÇ ±Ç¸®°¡ Áß¿äÇϱ⠶§¹®ÀÔ´Ï´Ù.

Á¦°¡ ³»½Ã°æÀ» ¹è¿ï ¶§(1994³â)¸¸ ÇÏ´õ¶óµµ ±³¼ö´Ô²²¼­ ³»½Ã°æÀ» »ðÀÔÇϸé Á¦°¡ ³»½Ã°æÀ» ¹Þ¾Æ¼­ °Ë»ç¸¦ ¸¶Ä¡´Â ¹æ½ÄÀ̾ú½À´Ï´Ù. Àß ¹è¿ìÁö ¸øÇÑ »óÅ¿¡¼­ ³»½Ã°æÀ» Àâ¾Ò±â ¶§¹®¿¡ ÀÌ·± Àú·± ÁÂÃæ¿ìµ¹µµ ¸¹¾ÒÁö¸¸ Àû¾îµµ ¼ú±â´Â »¡¸® ÀÍÈú ¼ö ÀÖ¾ú½À´Ï´Ù. ÀÌÁ¦´Â ´Þ¶óÁ³½À´Ï´Ù. ÀÏ´Ü ³»½Ã°æÀ» Àâ°í õõÈ÷ ¹è¿î´Ù´Â ¹æ½ÄÀº ´õ ÀÌ»ó ºÒ°¡´ÉÇØÁ³½À´Ï´Ù. ¸ÕÀú Àß ¹è¿î ÈÄ ³»½Ã°æÀ» Àâ¾Æ¾ß ÇÑ´Ù´Â °ÍÀÌ ½Ã´ëÀÇ ¿äûÀÔ´Ï´Ù. ¹Ù¶÷Á÷ÇÑ ¹æÇâÀÔ´Ï´Ù.

ÃÖ±Ù¿¡´Â óÀ½ºÎÅÍ ³¡±îÁö ±³¼ö ȤÀº ½Ã¼úÀÇ°¡ Á÷Á¢ ¸ðµç °ÍÀ» ½ÃÇàÇϵµ·Ï ¿äû¹Þ°í ÀÖ½À´Ï´Ù. Áß°£¿¡ ¼ÕÀ» ¹Ù²Ù±â ¾î·Æ½À´Ï´Ù. Àú¿¡°Ô ¿¹¾àµÈ ȯÀÚÀÇ ³»½Ã°æÀº 100% Á¦°¡ ÇÏ°í ÀÖ½À´Ï´Ù. »ðÀÔ, °üÂû, Á¶Á÷ °Ë»ç, °á°ú ±â·Ï µî ¸ðµç °ÍÀ» Àú È¥ÀÚ ÇÏ°í ÀÖ½À´Ï´Ù. ¹°·Ð observationÀº ¾ðÁ¦µçÁö °¡´ÉÇÕ´Ï´Ù. ´Ù¸¸ Àá½Ã ³»½Ã°æ½Ç¿¡ ¿À½Ã´õ¶óµµ observation¸¸ ÇÒ ¼ö ÀÖÀ» »ÓÀÔ´Ï´Ù. ³»½Ã°æÀ» Àâµµ·Ï Çã¿ëÇÒ ¼ö´Â ¾ø½À´Ï´Ù. Á÷Á¢ Çغ¼ ¼ö ¾øÀ¸¹Ç·Î ÁøÁ¤ÇÑ ÀǹÌÀÇ trainingÀº ¾Æ´Õ´Ï´Ù. ¹°·Ð simulator°¡ ÀÖ±â´Â ÇÕ´Ï´Ù¸¸, simulator´Â simulatorÀÏ »ÓÀÔ´Ï´Ù. Áï, ÀÏ»ó Áø·á¸¦ ÅëÇÏ¿© ´ë°­ ³»½Ã°æÀ» ¹è¿ì±â´Â ¾î·Æ´Ù´Â ¸»¾¸ÀÔ´Ï´Ù. º°µµÀÇ Á¤½Ä training course¸¦ ¹âÀ¸¼Å¾ß ÇÕ´Ï´Ù.

»ï¼º¼­¿ïº´¿ø ³»½Ã°æ½Ç¿¡¼­´Â Àü°øÀÇ ¹× fellow¸¦ À§ÇÑ ³»½Ã°æ ±âº» ÄÚ½º¸¦ 3°³¿ù·Î Àâ°í ÀÖ½À´Ï´Ù. µ¶¸³ÀûÀ¸·Î ³»½Ã°æÀ» ½ÃÇàÇϱâ À§Çؼ­´Â º´µ¿ ȸÁø°ú consult¸¦ Á¦¿ÜÇÏ°í 3°³¿ù full time trainingÀº ÇÊ¿äÇÏ´Ù°í »ý°¢Çϱ⠶§¹®ÀÔ´Ï´Ù. ÀúÈñÀÇ training programÀº endotoday.com¿¡¼­ º¸½Ç ¼ö ÀÖ½À´Ï´Ù (EndoTODAY SMC basic endoscopy training course, 3 months). ¼ÒÈ­±â³»°ú subspecialÀ» ¼±ÅÃÇÑ ¼Ò¼öÀÇ Àü°øÀǸ¸ µ¶¸³ÀûÀ¸·Î ³»½Ã°æÀ» ÇÒ ¼ö ÀÖ´Â ¼öÁØÀÇ ±³À°ÀÌ ÀÌ·ç¾îÁý´Ï´Ù. ¾Æ½±Áö¸¸ ´Ù¸¥ subspecial Àü°øÀǵéÀº ³»½Ã°æ ±âº» ÀÌ·Ð ±³À° ¹× simulator ÈÆ·Ã Á¤µµ¿¡ ±×Ä¡°í ÀÖ½À´Ï´Ù.

Àú´Â ¿Ü°ú ÀÇ»çÀÇ ³»½Ã°æ¿¡ ¹Ý´ëÇÏÁö ¾Ê½À´Ï´Ù. ÃæºÐÇÑ training ÈÄ ³»½Ã°æÀ» Àâ¾Æ¾ß ÇÑ´Ù´Â Á¡À» °­Á¶ÇÒ »ÓÀÔ´Ï´Ù. »ý°¢º¸´Ù ½Ã°£ÀÌ ¸¹ÀÌ ÇÊ¿äÇÕ´Ï´Ù. ¸î Áַδ ºÒ°¡´ÉÇÕ´Ï´Ù. ÃÖ¼ÒÇÑ ¸î °³¿ùÀÇ full time trainingÀÌ ÇÊ¿äÇÏ´Ù´Â Á¡À» ÀØÁö ¸¶½Ã±â ¹Ù¶ø´Ï´Ù. ÀúÈñ´Â ¿­·ÁÀÖ½À´Ï´Ù. ¿øÇÏ´Â ºÐµéÀº ¼º½É²¯ ±³À°ÇÏ°í ÀÖ½À´Ï´Ù. ´Ù¸¸ ÃæºÐÇÑ ½Ã°£À» Áֽñ⠹ٶø´Ï´Ù."



© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.