EndoTODAY | EndoATLAS | Outpatient Clinic

Parasite | Esophagus | Stomach | Cancer | ESD

Home | Guide | Author | Subscription | Links


[Á¦112ȸ ³»½Ã°æÇÐȸ Áý´ãȸ (¼­¿ï¾Æ»êº´¿ø)]

1. Anal melanoma (¼­¿ï´ëº´¿ø ¹ÚÀç¿ë)

Anal melanoma·Î transanal resection ÈÄ recurÇÏ¿© Miles' op ÇÏ¿´À¸³ª ´Ù½Ã Àç¹ß ÈÄ multiple metastasis¸¦ º¸ÀÓ.

óÀ½¿¡ transanal resectionÀ» ÇÏÁö ¸»°í Á» ´õ Àû±ØÀûÀÎ Ä¡·á¸¦ Çß¾úÀ¸¸é ¾î¶°ÇÏ¿´À»Áö Áú¹®ÀÌ ÀÖ¾ú½À´Ï´Ù. º¯Á¤½Ä ±³¼ö´ÔÀº local excision°ú wide excision¿¡ ¿¹ÈÄ Â÷ÀÌ°¡ ¾ø´Ù°í comment Çϼ̽À´Ï´Ù.

* ÂüÁ¶: EndoTODAY ½Äµµ ¾Ç¼º Èæ»öÁ¾


2. ¹Ýº¹ÀûÀÎ ³»½Ã°æ Ä¡·á·Î È£ÀüµÈ gastric angiodysplasia (¼­¿ï¼º¸ðº´¿ø ÀÌ°æÁø)

F/27. ¸¸¼º ºóÇ÷. Melena

À§¿¡ ´Ù¹ß¼º telangiectasia°¡ °üÂûµÇ¾ú°í ÀϺο¡¼­ oozingÀ» º¸¿´À½. APC ablationÀ» ¿©·¯¹ø (10ȸ) ½ÃÇàÇÑ ÈÄ ÇöÀç´Â ´õ ÀÌ»ó ÃâÇ÷ ¾øÀÌ stableÇÑ »óÅÂÀÓ.

»çÁø ÃÔ¿µÀ» ¸øÇÏ¿© Á¦ ȯÀÚ »çÁø Áß °¡Àå ºñ½ÁÇÑ °ÍÀ» °ñ¶ó¼­ ¼Ò°³ÇÕ´Ï´Ù.

¹ÚÀç¸í ±³¼ö´Ô²²¼­´Â APC settingÀº Effect 3, 70 Watt¸¦ »ç¿ëÇß´Ù°í ÇÕ´Ï´Ù. ¾Æ¿ï·¯ APC ablation º¸´Ù Coagrasper¸¦ ÀÌ¿ëÇÑ Soft CoagÀÌ ´õ È¿°ú°¡ ÁÁÀº °Í °°´Ù°í µ¡ºÙÀ̼̽À´Ï´Ù. ÀÌÇ׶ô ±³¼ö´ÔÀº 80 Watt¸¦ »ç¿ëÇϸé È¿°ú°¡ ´õ ÁÁÀº °Í °°´Ù°í comment Çϼ̽À´Ï´Ù.


3. [Teleconference] Ulcerative colitis, deep remission after long-lasting mesalazine-induced pancytopenia (Á¦ÁÖ´ëÇб³ ¼ÛÇöÁÖ)

Azathioprine¿¡ ÀÇÇÑ cytopenia°¡ ÀÖ¾ú´ø ȯÀÚ¿¡¼­ mesalazine »ç¿ë ÈÄ ´Ù½Ã cytopenia°¡ ¹ß»ýÇÑ Á¡ÀÌ Æ¯ÀÌÇÑ Á¡À̾ú½À´Ï´Ù. ÇöÀç´Â deep remission »óÅ·Π¾àÀ» ²÷¾úÁö¸¸, ÇâÈÄ Àç¹ßÇϸé TNF-alpha inhibitor¸¦ °í·ÁÇÏ°í ÀÖ´Ù°í ÇÕ´Ï´Ù. Azathioprine°ú 5-ASA¸¦ ¾µ ¼ö ¾øÀ¸´Ï±î...

¾ç¼®±Õ ±³¼ö´Ô²²¼­´Â sulfasalazine¿¡ ÀÇÇÑ pancytopenia´Â °£È¤ °æÇèÇÒ ¼ö ÀÖÀ¸³ª 5-ASA¿¡ ÀÇÇÑ pancytopenia´Â °æÇèÇÑ ÀûÀÌ ¾ø´Ù°í comment Çϼ̽À´Ï´Ù. ¸Å¿ì µå¹® ÀÏÀÎ °Í °°½À´Ï´Ù.

Âü°í: °©Àڱ⠱ñÝÇØÁ®¼­ ã¾Æº¸¾Ò½À´Ï´Ù. Mesalazine°ú mesalamineÀº °°Àº ¾àÀÔ´Ï´Ù. ¿µ±¹¿¡¼­´Â mesalazineÀ̶ó ºÎ¸£°í ¹Ì±¹¿¡¼­´Â mesalamineÀ̶ó ºÎ¸¨´Ï´Ù.


4. PEG »ðÀÔ ÈÄ ¹ß»ýÇÑ ±âÁ¾Áõ

F/67, ALS.

PEG »ðÀԽà irritable ÇÏ¿´À½.

PEG tube »ðÀÔ ÈÄ diet¸¦ ½ÃÀÛÇÏ¿´´Âµ¥ intraabdominal abscess°¡ ¹ß»ýÇÏ¿´½À´Ï´Ù. ÀÌÈÄ PEG tube »ðÀÔºÎÀÇ ±Ë¾çµµ È®ÀεǾú½À´Ï´Ù. ´ÙÇེ·´°Ô PCD¿Í ¼ö¼ú·Î Àß È¸º¹µÇ¾ú´Ù°í ÇÕ´Ï´Ù.

ÀÌÁØÇà comment: ALS ȯÀÚ´Â º¸Åë sedationÀÌ ³Ê¹« Àß µÇ¼­ °ÆÁ¤Àä, ÀÌ È¯ÀÚ´Â irritableÇÏ¿© ½Ã¼úÀÌ ¾î·Á¿ü´Ù´Ï ÀÌ»óÇÑ ÀÏÀÔ´Ï´Ù. Ȥ½Ã midazolamÀÌ °ú·® Åõ¿©µÇ¾ú±â ¶§¹®Àº ¾Æ´ÑÁö »ìÆ캼 ÇÊ¿ä°¡ ÀÖ½À´Ï´Ù.

Áý´ãȸ ÈÄ ¼Û³âȸ ÀÚ¸®¿¡¼­ ¿©·¯ ¼±»ý´ÔµéÀÇ ÀÇ°ß: (1) PEG »ðÀÔ ÈÄ anchor¸¦ ³Ê¹« ´À½¼ÇÏ°Ô °íÁ¤ÇÏ¿´´ø °Í °°´Ù. (2) pneumoperitoneum°ú abscess ÈÄ¿¡´Â ¹Ý´ë·Î PEG anchor¸¦ ³Ê¹« ´Ü´ÜÇÏ°Ô °íÁ¤ÇÏ¿© internal bumper¿¡ ´­·Á ulcer°¡ »ý°å´ø °Í ¾Æ´Ò±î? (3) Abscess µîÀÌ ¹ß»ýÇÑ »óȲ¿¡¼­ ¼ö¼ú ´ë½Å PCD¸¦ °í·ÁÇØ º¼ ¼ö ÀÖ°ÚÁö¸¸, ¹®Á¦°¡ µÇ´Â PEG tube´Â ¿ì¼± Á¦°ÅÇÏ´Â °ÍÀÌ ¿ÇÁö ¾Ê¾ÒÀ»±î?

* Âü°í: EndoTODAY PEG


6. POEM and ARES (ºÐ´çÂ÷º´¿ø È«¼Ò´ã)

µÎ Áõ·Ê°¡ ¹ßÇ¥µÇ¾ú½À´Ï´Ù. POEM ÈÄ ¿ª·ù Áõ¼¼°¡ ÀÖ¾î ESD ¹æ¹ýÀ¸·Î ARES (anti-reflux endoscopic surgery) ½ÃÇàÇÔ.

¹ßÇ¥ÀÚ´Â POEM ÈÄ 30%¿¡¼­ reflux°¡ ¹ß»ýÇÏ°í ´ëºÎºÐ PPI·Î Á¶ÀýµÇÁö¸¸ PPI¿¡ ¹ÝÀÀÇÏÁö ¾ÊÀ¸¸é LARS³ª ARES¸¦ Àû¿ëÇÒ ¼ö ÀÖ´Ù°í ¸®ºäÇϼ̽À´Ï´Ù.

Jackhammer esophagus ȯÀÚ¿¡¼­ LES myotomy¸¦ ÇÏ¿© ¿ª·ù°¡ ¹ß»ýÇÑ °ÍÀ̹ǷΠÁ¶ÁÖ¿µ ±³¼ö´Ô²²¼­´Â LES myotomy¸¦ ÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁ°Ú´Ù°í comment Çϼ̽À´Ï´Ù. ¾Æ»êº´¿ø Ãֱ⵷ ¼±»ý´Ô²²¼­´Â LES myotomy¸¦ ÇÏÁö ¾ÊÀ¸¸é achalasiaó·³ ÁøÇàÇÏ´Â ¼ö°¡ ÀÖ´Ù°í comment Çϼ̽À´Ï´Ù.

* EndoTODAY Achalasia and POEM


7. Internal incarceration of small bowel following colonoscopy (¼­¿ï¾Æ»êº´¿ø ¼­¸í¼÷)

´ëÀå³»½Ã°æ ÈÄ º¹Åë.

°ú°Å º¹ºÎ ¼ö¼ú·ÂÀÌ ÀÖ¾úÀ½. ´ëÀå ³»½Ã°æ °Ë»ç ÈÄ º¹ÅëÀÌ ¹ß»ýÇÏ¿© CT¸¦ Âï¾ú´Âµ¥, õ°øÀº ¾ø¾ú°í ´ë½Å adhesion band·Î »ý°¢µÇ´Â ºÎÀ§°¡ º¸¿´°í ¼ÒÀå ÀϺΰ¡ È®ÀåµÇ¾î ÀÖ¾úÀ½. ¼ö¼úÀ» ½ÃÇàÇÔ

¹ßÇ¥ÀÚ´Â º¹ºÎ¼ö¼ú·ÂÀÌ Àִ ȯÀÚÀÇ °æ¿ì ´ëÀå³»½Ã°æ ÈÄ º¹ÅëÀÌ ¹ß»ýÇÏ¿´À» ¶§ õ°ø ÀÌ¿Ü¿¡µµ internal incarcerationÀ» °í·ÁÇØ¾ß ÇÒ °Í °°´Ù°í ¸®ºäÇϼ̽À´Ï´Ù.

±¹³»¿¡¼­µµ Áõ·Ê º¸°í°¡ ÀÖÀ¸¹Ç·Î »ìÆ캸½Ã¸é ÁÁÀ» °Í °°½À´Ï´Ù.


[ÀÌÁØÇà È¥À㸻]

1) ȸ¿ø°£ÀÇ ´ÜÇÕµµ Áß¿äÇÏÁö¸¸ Çй®Àû Åä·ÐÀº ´õ Áß¿äÇÕ´Ï´Ù. ÇÐȸ Áý´ãȸ´Â ÃæºÐÇÑ ½Ã°£À» °¡Áö°í ³¡Àå Åä·ÐÀ» ÇØ¾ß ÇÕ´Ï´Ù. °è¼Ó ½Ã°è¸¦ º¸¸é¼­ ¹ßÇ¥ÇÏ°í, Èĵü ³¡³»°í ¹ä¸ÔÀ¸·¯ °¡´Â ÀüÅë(?) ȤÀº Æó½ÀÀº »¡¸® ¾ø¾Ö´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. ±è¹ä ¸ÔÀ¸¸é¼­ 2½Ã°£ÀÌ°í 3½Ã°£ÀÌ°í ³¡±îÁö Åä·ÐÇغ¸¸é ¾î¶³±î¿ä?

2) ¼Û³âȸ ¸ðÀÓ¿¡´Â ÆøźÁÖ°¡ ºüÁú ¼ö ¾øÀ»±î¿ä? È­¿äÀÏ Àú³á ¼Û³âȸ ÀÚ¸®¿´½À´Ï´Ù. ´ÙÀ½ ³¯ ¿ÀÀü ³»½Ã°æ ½Ã¼úÀ̳ª ¿Ü·¡ Áø·áÀÎ ºÐµéÀÌ »ó´çÈ÷ ¸¹¾ÒÀ» °Í °°½À´Ï´Ù. ´ÙÀ½ ³¯ ¾Æħ Áø·á°¡ ÀÖ´Ù¸é ¼úÀº ÃÖ¼ÒÇÑÀ¸·Î ÁÙÀÌ´Â °ÍÀÌ ÁÁÀ» °Í °°½À´Ï´Ù. ȯÀڵ鿡 ´ëÇÑ ¿¹ÀÇ ¹®Á¦ÀÔ´Ï´Ù. Áöų °ÍÀº ÁöÅ°°í ¿ä±¸ÇÒ °ÍÀº ¿ä±¸ÇØ¾ß ÇÕ´Ï´Ù.

ÀÌ·± »ý°¢ÀÌ µé¾î¼­ Á¦°Ô µ¹¾Æ¿Â ÆøźÁÖ´Â ÅðÁÖÀÜ¿¡ ¹ö·È°í, ´ë½Å »çÀÌ´Ù¸¦ ¸¶¼Ì½À´Ï´Ù. ±×¸®°í ÀÏÂï ÀÚ¸®¸¦ ¶¹½À´Ï´Ù. °è¼Ó ÀÌ·¸°Ô »ì´Ù°¡´Â ÇÐȸ¿¡¼­ ¸ÅÀåµÉÁö ¸ð¸£°Ú½À´Ï´Ù¸¸... ¿©ÇÏÆ° ´«Ä¡º¸Áö ¾Ê°í »ì·Á°í ÇÕ´Ï´Ù. ³» »ý°¢´ë·Î »ì±â.


[References]

1) ³»½Ã°æÇÐȸ ÇмúÇà»ç on-line Áß°è

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