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EndoTODAY ³»½Ã°æ ±³½Ç


[À§½ÄµµÁ¢ÇպξÏ. gastroesophageal junction (GEJ) cancer] - ðû

1. À§½ÄµµÁ¢ÇպΠÅë°ú¹ý Passing the GE junction

2. À§½ÄµµÁ¢ÇպΠ°üÂû¹ý Observation of the GE junction

3. Symposiums

4. Cases

5. FAQ

6. References

2018³â ³»½Ã°æ ¼¼¹Ì³ª °­ÀÇ

2022-11-2. KLASS-11 ¿¬±¸ÀÚ¸ðÀÓ


1. À§½ÄµµÁ¢ÇպΠÅë°ú¹ý

ÃʽÉÀÚ¿¡°Ô´Â À§½ÄµµÁ¢ÇպΠÅë°ú°¡ ¾î·Á¿ï ¼ö ÀÖ½À´Ï´Ù. ÇϺνĵµ´Â straight ÇÏÁö ¾ÊÀ¸¸ç (= curved esophagus) ȯÀÚ¸¶´Ù ¸ð¾çÀÌ ´Ù¸£±â ¶§¹®ÀÔ´Ï´Ù. ÇϺνĵµ À§½ÄµµÁ¢¹äºÎ 2-3cm À§ÂÊÀÌ ±¸ºÒ±¸ºÒÇÑ ¿¹´Â ¾ÆÁÖ ¸¹½À´Ï´Ù. Á¦ °æÇèÀ¸·Î´Â »çÁø »ó 3½Ã¿¡¼­ 6½Ã ¹æÇâÀÌ ¹Ý´Þ ¸ð¾çÀ¸·Î ¾à°£ µÎÅùÇÏ°Ô Æ¢¾î³ª¿Â ȯÀÚ°¡ ¸¹Àº °Í °°½À´Ï´Ù. ¾à°£ÀÇ sliding hiatal hernia´Â °í·É¿¡¼­´Â °ÅÀÇ normalÀÔ´Ï´Ù.

À§½ÄµµÁ¢Çպθ¦ Åë°úÇϸ鼭 ¾ÆÁÖ Á¶±Ý upÀ» °É¸é¼­ ³»½Ã°æ Á¶ÀۺΠºÎÃ÷¸¦ ¶³¾î¶ß¸®½Ê½Ã¿ä. ³»½Ã°æ ³¡ÀÌ ÀÚ¿¬½º·´°Ô ÁÂÃø fundus¸¦ ÇâÇϱ⠶§¹®¿¡ À§·Î µé¾î°¡±â ÁÁ½À´Ï´Ù. À§(êÖ)·Î µé¾î°¡¸é Áï½Ã ³»½Ã°æ Á¶ÀۺΠºÎÃ÷¸¦ µé¾î ¿Ã¸®¸é¼­ scope¸¦ ½Ã°è¹æÇâÀ¸·Î µ¹¸®¸é¼­ ¿À¸¥ÂÊÀ¸·Î ÁøÀÔÇϽñ⠹ٶø´Ï´Ù. 'Á¶±Ý ÁÂȸÀü ÇÏ¿´´Ù°¡ ¹Ù·Î ¿ìȸÀü'ÇÏ´Â ´À³¦ÀÔ´Ï´Ù.

À§½ÄµµÁ¢ÇպΠÅë°ú µ¿¿µ»óÀÔ´Ï´Ù. ÁÂȸÀü ÇÏ¿´´Ù°¡ ¿ìȸÀü ÇÏ´Â ±âºÐÀ» ´À²¸º¸½Ã±â ¹Ù¶ø´Ï´Ù.


2. À§½ÄµµÁ¢ÇպΠ°üÂû¹ý

[2020-5-20. ¾Öµ¶ÀÚ Áú¹®]

Ȥ½Ã EGJ¸¦ Àß °üÂûÇÒ ¼ö ÀÖ´Â ¹æ¹ýÀÌ ÀÖÀ»±î¿ä? Sliding hernia°¡ Àְųª ºñ¼ö¸é ³»½Ã°æ½Ã ȯÀÚºÐÀÌ °í¸¿°Ôµµ(?) ±¸¿ªÁúÀ» ÇØÁÖ¸é EGJ°¡ ±³°ú¼­¿¡ º¸ÀÌ´Â °Íó·³ Àß º¸À̴µ¥ ¼ö¸éÀ¸·Î ³»½Ã°æ ÇÏ´Â ºÐµéÀÇ °æ¿ì¿¡´Â ÆìÁø ¸ð¾çÀ» °üÂûÇϱⰡ ¾î·Æ½À´Ï´Ù. Ȥ½Ã Àß º¼ ¼ö ÀÖ´Â ¹æ¹ýÀÌ ÀÖÀ»±î ±Ã±ÝÇÕ´Ï´Ù.

[2020-5-21. ÀÌÁØÇà ´äº¯]

À§½ÄµµÁ¢Çպδ tubularÇÑ ½Äµµ¿Í saccularÇÑ À§°¡ ¸¸³ª´Â ºÎÀ§ÀÔ´Ï´Ù. Á» ´õ ±ÙÁ¢ÇÏ¿© °üÂûÇϸé palisading zoneÀÌ ³¡³ª´Â ºÎÀ§ÀÔ´Ï´Ù.

À§½ÄµµÁ¢Çպθ¦ ³ª´©´Â °¡Àå Áß¿äÇÑ ÇغÎÇÐÀû ±âÁØÀº À§Á¡¸·ÀÔ´Ï´Ù. Gastric foldÀÇ proximal marginÀÌ À§½ÄµµÁ¢ÇպΠÆÇÁ¤ÀÇ °¡Àå Áß¿äÇÑ landmarkÀÎ °ÍÀÌÁö¿ä. ÀÌ ºÎÀ§´Â ù° palisading zoneÀÇ distal end¿Í ÀÏÄ¡ÇÏ°í, µÑ° È£Èí¿¡ ÀÇÇÏ¿© ¿­·È´Ù ´ÝÄ¡´Â ºÎÀ§, Áï pinchcock action°úµµ ÀÏÄ¡ÇÒ »Ó¸¸ ¾Æ´Ï¶ó, ¼Â° Á¶Á÷ÇÐÀûÀ¸·Î´Â squamocolumnar junction°ú °ÅÀÇ °°Àº ºÎÀ§ÀÔ´Ï´Ù. ½Äµµ¿­°øÅ»Àå ȤÀº ¹Ù·¿½Äµµ¿¡¼­´Â ÀÌ·¯ÇÑ °ü°è°¡ ±úÁö°Ô µË´Ï´Ù.

À§½ÄµµÁ¢Çպΰ¡ ¿ÏÀüÈ÷ Á¤»óÀΠȯÀÚ¿¡¼­ ÀÌ ºÎÀ§¸¦ Àß °üÂûÇϱâ´Â ¾î·Æ½À´Ï´Ù. ¿ÀÈ÷·Á sliding typeÀÇ ½Äµµ¿­°øÅ»ÀåÀÌ ¾à°£ Àִ ȯÀÚ¿¡¼­ À§½ÄµµÁ¢ÇպΠ°üÂûÀÌ ½±½À´Ï´Ù. ¾Æ·¡ ±×¸²Àº ¶Ñ·ÇÇÑ ½Äµµ¿­°øÅ»ÀåÀÔ´Ï´Ù. À§½ÄµµÁ¢Çպΰ¡ È­»ìÇ¥¿Í °°ÀÌ È¾°æ¸·À¸·ÎºÎÅÍ »ó¹æÀ¸·Î À̵¿ÇÕ´Ï´Ù. Ⱦ°æ¸· level¿¡ ÀÖ¾î¾ß ÇÒ squamocolumnar junctionÀÌ À̺¸´Ù ¸î cm »ó¹æ¿¡¼­ B ring, Áï mucosal ringÀ» ÀÌ·ç¸ç ³»°­ÂÊÀ¸·Î ¾à°£ indentationÀ» º¸ÀÌ°Ô µË´Ï´Ù. Ⱦ°æ¸·°ú B ring »çÀÌ°¡ hernia sacÀÔ´Ï´Ù. ÀÌó·³ ¶Ñ·ÇÇÏÁö ¾Ê´õ¶óµµ °¡º­¿î Å»ÀåÀÌ Àִ ȯÀÚ´Â ¸Å¿ì ¸¹½À´Ï´Ù. ¾ÆÁÖ ¾à°£ÀÇ Å»ÀåÀº °í·É¿¡¼­´Â °ÅÀÇ Á¤»ó¼Ò°ßÀÔ´Ï´Ù.

Sliding hiatal herniaÀÇ ¹ß»ýÀº ÁÖ·Î phrenoesophageal ligamentÀÇ ´Ã¾îÁü°ú °ü·ÃµÇ¾î ÀÖ½À´Ï´Ù (EndoTODAY Pathogenesis of hiatal hernia).

Hiatal hernia°¡ ¿À·¡µÇ¾î fixed µÇ±â Àü±îÁö phrenoesophageal ligament´Â ´Ã¾î³ª ÀÖÀ¸³ª ½Äµµ°¡ ª¾ÆÁöÁö´Â ¾Ê¾Æ¼­ ¾î´À Á¤µµÀÇ reducibility¸¦ º¸ÀÔ´Ï´Ù. °ø±â¸¦ ³Ö±â Àü°ú ³ÖÀº ÈÄ°¡ ´Ù¸£°í, È£Èí¿¡ µû¶ó ´Ù¸£°í, ³»½Ã°æ ³ÖÀ» ¶§¿Í ³ª¿Ã ¶§°¡ ´Ù¸¥ ÀÌÀ¯ÀÔ´Ï´Ù.

À§½ÄµµÁ¢Çպθ¦ Àß °üÂûÇϱâ À§ÇÑ Æ¯º°ÇÑ tipÀº ¾ø½À´Ï´Ù. õõÈ÷ ¿©·¯¹ø º¸´Â ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù¸¸... ±×·¡µµ ¼¼ °¡Áö¸¦ ¸»¾¸µå¸³´Ï´Ù.

(1) °ø±â ÁÖÀÔ°ú È£Èí¿¡ À¯ÀÇÇϽʽÿÀ. À§½ÄµµÁ¢Çպΰ¡ Á¤»óÀÎ ºÐ, Áï phrenoesophageal ligament°¡ ÀüÇô ´Ã¾îÁöÁö ¾ÊÀº ºÐÀÌ¶óµµ ³»½Ã°æ °Ë»ç¸¦ Çϸ鼭 À§¿¡ °ø±â¸¦ ÀûÀýÈ÷ ³ÖÀº »óÅ¿¡¼­ ȯÀÚÀÇ È£ÈíÀ» º¸¸é¼­ õõÈ÷ °üÂûÇϸé squamocolumar junctionÀÌ ¾à°£ ¿Ã¶ó¿Â »óŸ¦ ¸¸³¯ ¼ö ÀÖÀ¸¸ç ÀÌ ¶§ À§½ÄµµÁ¢Çպθ¦ °¡Àå Àß °üÂûÇÒ ¼ö ÀÖ½À´Ï´Ù. ¾à°£ÀÇ sliding hiatal hernia°¡ Àִ ȯÀÚ¿¡¼­´Â ´õ¿í Àß º¸ÀÔ´Ï´Ù.

(2) ³»½Ã°æÀÌ µé¾î°¥ ¶§ Á¶±Ý¾¿ °ø±â¸¦ ³Ö¾î°¡¸é¼­ ½Äµµ¸¦ õõÈ÷ Åë°úÇϽʽÿÀ. ƯÈ÷ EG junction ºÎÀ§´Â µé¾î°¡¸é¼­ ÀÚ¼¼È÷ °üÂûÇÒ °ÍÀ» ±ÇÇÕ´Ï´Ù. ³ª¿À¸é¼­ °üÂûÇϱ⠾î·Á¿î °æ¿ì°¡ ¸¹½À´Ï´Ù. µé¾î°¡¸é¼­ ÇÑ ¹ø, ³ª¿À¸é¼­ ÇÑ ¹ø °üÂûÇÏ´Â °ÍÀÌ ÃÖ¼±ÀÔ´Ï´Ù.

(3) Retroflection setting¿¡¼­ cardia¸¦ °üÂûÇÒ ¶§ µ¿ÀÛÀ» õõÈ÷ ÇϽñ⠹ٶø´Ï´Ù. ³»½Ã°æÀ» È×ÇÏ°í ºü¸£°Ô µ¹¸®¸é À§½ÄµµÁ¢Çպδ °ÅÀÇ °üÂûÇÒ ¼ö ¾ø½À´Ï´Ù.

¾Æ·¡´Â À§½ÄµµÁ¢ÇպξÏÀ¸·Î ÀÇ·Ú¹ÞÀº ȯÀÚÀÇ »çÁøÀÔ´Ï´Ù. ÀÇ·ÚÁֽŠ¼±»ý´Ô²²¼­´Â ½Äµµ¿¡¼­ À§·Î µé¾î°¡´Â °úÁ¤¿¡ cardia¿¡ ¹º°¡ ÀÌ»óÀÌ ÀÖÀ½À» ¹ß°ßÇϼ̽À´Ï´Ù (5,6¹ø° »çÁø). À§¸¦ °ñ°í·ç °üÂûÇÑ ÈÄ retroflection »óÅ¿¡¼­ cardia¸¦ Æò°¡ÇÏ°íÀÚ ³ë·ÂÇϼ̴ø °Í °°Àºµ¥ ÁÁÀº »çÁøÀº ¾ø½À´Ï´Ù. ¾Æ¸¶ retreflectionÀ¸·Î Àß º¸±â ¾î·Á¿î º´¼Ò¿´´ø ¸ð¾çÀÔ´Ï´Ù. ³ª¿À¸é¼­ ´Ù½Ã °üÂûÇÏ°í (³ë¶õ»ö box) Á¶Á÷°Ë»ç¸¦ Çϼ̽À´Ï´Ù. ´Ù½Ã ºÁµµ ¸ÚÁø °Ë»çÀÔ´Ï´Ù. ³õÄ¡±â ½¬¿î µé¹®¾ÏÀ» Àß ¹ß°ßÇÏ°í Àß Æò°¡ÇØ Áּ̽À´Ï´Ù.

¿ä¾àÇÕ´Ï´Ù. À§½ÄµµÁ¢ÇպΠ°üÂûÀº ¾î·Æ½À´Ï´Ù. ÀÌ ºÎÀ§ÀÇ ¾Ï(Á¢ÇպξÏ)Àº À°¾È¼Ò°ß¿¡ ºñÇÏ¿© ½ÉÇÑ °æ¿ìµµ ¸¹½À´Ï´Ù. °á±¹ ÁÁÀº ³»½Ã°æ ½À°üÀÌ ÇÊ¿äÇÕ´Ï´Ù. À§½Äµµ Á¢Çպδ µé¾î°¡¸é¼­ Àß º¸°í, retroflectionÇؼ­ ´Ù½Ã Çѹø Àß º¸°í, ³ª¿À¸é¼­µµ ¼¼¹ø°·Î Àß º¸´Â ½À°üÀÌ ÇÊ¿äÇÕ´Ï´Ù.


3. Symposium

[2018-4-26. KINGCA symposium] GEJ Cancer - General principle

1) History of GEJ cancer treatment strategy (Arnulf H. Holscher)

À¯·´¿¡¼­´Â Siewert ºÐ·ù(Chirurg 1987;58:25-32)°¡, ÀϺ»¿¡¼­´Â Nishi ºÐ·ù(1973)°¡ »ç¿ëµË´Ï´Ù.

ìíÜâãÝÔ³äßÝÂ×¾, 2017

2) Endoscopic finding and results of ESD (Ichiro Oda)

Clinicopatholgical characteristics of early GEJ cancer
Male
Differentiated type
HP -
Gastric atrophy -
0~6 o'clock location
IIc or IIa
Reddish in color

His angle¿¡ À§Ä¡ÇÑ GEJ cancerÀÇ ³»½Ã°æ Ä¡·á Àü·«: ½Äµµ ÂÊÀ» ¸ÕÀú ÀýÁ¦ÇÑ ÈÄ À§ ºÎºÐÀ» ÀýÁ¦ÇÑ´Ù. Oda ¼±»ý´ÔÀº Dual knife·Î precuttingÀ» ÇÏ°í IT-2 knife·Î submucosal dissectionÀ» ÇÏ´Â ºñµð¿À Ŭ¸³À» º¸¿©ÁÖ¾ú½À´Ï´Ù.

µ¿°æ¾Ï¼¾ÅÍ¿¡¼­´Â ¸Å³â gastric ESD 500¿¹, ½Äµµ ESD 200¿¹ Á¤µµ ½ÃÇàµÇÁö¸¸ GEJ ¾Ï¿¡ ´ëÇÑ ESD´Â 5-10¿¹ Á¤µµ ½ÃÇàµÈ´Ù°í ÇÕ´Ï´Ù.

3) LN metastasis & recurrence patten (¿ï»ê´ë ÀÌÀμ·)

µ¶ÀÏ ÀÚ·á: Feith M. Surg Oncol Clin N Am 2006, Gertler R. Ann Surg 2014

ÀϺ» ÀÚ·á: Yamashita. Gastric Cancer 2017

Çѱ¹ ÀÚ·á: Suh. Ann Surg Oncol 2017

4) Upfront surgery vs. CCRTx: from the view of oncologist compared to esophageal cancer (ÃæºÏ´ë Ç÷¾×Á¾¾ç³»°ú ÇÑÇý¼÷)

GEJ adenocarcinoma is a 'Zone Disease' rather than an 'Oragn disease'

Type I GEJ adenocarcinoma should be regarded as similar to esophageal cancers, and treated like esophageal cancer with preoperative CCRT followed by esophagectomy and mediastinal lymphadenectomy.

Type II and III GEJ adenocarcinoma should be regarded as similar to gastric cancers, and treated like gastric cancer with total gastrectomy and D2 lymphadenectomy.

* Âü°í 1: Japanese classification of esophageal cancer, 2017

* Âü°í 2: ÀϺ» ½ÄµµÁúȯÇÐȸ ¸²ÇÁÀý ¸í¸í¹ý (Esophagus 2004;1:61-88)


[2022-12-3] Seoul International Gastric Cancer Forum 2022

[Fenglin Liu, Fudan Univesity, China] EG junction cancer - history and present consensus

[Kurokawa Yukinori, Osaka University, Japan] Mediastinal lymph node dissection for EGJ cancer

[¹Ú¼º¼ö °í·Á´ë] Anti-reflux surgery

[Takeshi Sano. Cancer Institute Hospital, Japan] IGCA : past, present and future.


4. Cases

[µé¹®¾Ï 1¿¹ (EndoTODAY À§¾Ï 514)]

µé¹®¾ÏÀÔ´Ï´Ù. ÀÇ·Ú¹ÞÀ» ´ç½Ã Á¶Á÷°Ë»ç´Â adenocarcinoma, M/D¿´½À´Ï´Ù. ¿ÜºÎ ³»½Ã°æ »çÁø¿¡¼­ ¶Ñ·ÇÇÑ ±Ë¾çÀÌ ÀÖ¾ú±â ¶§¹®¿¡ óÀ½ºÎÅÍ ³»½Ã°æ Ä¡·á¸¦ °í·ÁÇÏÁö ¾Ê°í ¼ö¼úÀ» ÃßõÇÏ¿´½À´Ï´Ù. 'Á¶±âÀ§¾ÏÀÌÁö ¾ÊÀ»±î? SM cancer Á¤µµ µÇÁö ¾ÊÀ»±î?' »ý°¢Çß½À´Ï´Ù.

ù ¹ß°ß ´ç½Ã ³»½Ã°æ

ÀÇ·Ú ÈÄ ³»½Ã°æ Àç°Ë

±×·±µ¥ CT °Ë»ç¿¡¼­ cardia¿Í À§Ã¼»óºÎ ¼Ò¸¸ÀÇ º®ÀÌ µÎ²®°í ÁÖº¯ÀÇ lymph nodeµéÀÌ Ä¿Á®ÀÖ´Ù´Â Æǵ¶À» ¹Þ¾Ò½À´Ï´Ù. ¿µ»óÀÇÇаú ¼±»ý´ÔÀÌ ESD¸¦ ÇÏ¸é ¾ÈµÈ´Ù°í Ä£ÀýÇÏ°Ô comment¸¦ Áּ̽À´Ï´Ù ("ESD º¸´Ù´Â surgical resectionÀ» °í·ÁÇϽñ⠹ٶ÷"). ¾Ë¾Æ¼­ ÇÒÅÙµ¥ Âü º°ÀÏÀ̱º... Á¤µµ·Î °¡º±°Ô »ý°¢ÇÏ°í ³Ñ¾î°¬½À´Ï´Ù. ±×·±µ¥ ÃÖÁ¾ º´¸®°á°ú¸¦ º¸´Ï... CT Æǵ¶À» Âü Àß Çß´Ù´Â »ý°¢ÀÌ µé¾ú½À´Ï´Ù.

¼ö¼ú ÈÄ º´¸®°á°ú´Â ´Ù¼Ò ³î¶ó¿ü½À´Ï´Ù.

Stomach, total gastrectomy:
Advanced gastric carcinoma
1. Location : upper third, Center at cardia (Siewert III)
2. Gross type : AGC type (Borrmann type III) (mimicking EGC III)
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 2.7x2.5 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: proximal 1.1 cm, distal 13.5 cm
8. Lymph node metastasis : metastasis to 8 out of 45 regional lymph nodes (pN3a), (perinodal extension: present) (8/45: "1", 0/0; "2", 0/0; "3", 1/7; "4", 0/4; "5", 0/0; "6", 0/5; "7 (left gastric)", 2/6; "8a", 0/3; "9 (celiac artery)", 4/6; "11p", 0/7; "12a", 0/3; "4sb", 0/2; perigastric, 1/2)
9. Lymphatic invasion : present
10. Venous invasion : present(intra- and extramural)
11. Perineural invasion : present
12. AJCC stage by 7th edition: pT3 N3a

Lymph node stationÀ» ´Ù½Ã Çѹø »ý°¢ÇØ º¸¾Ò½À´Ï´Ù. º´¼Ò¿¡¼­ ´Ù¼Ò ¶³¾îÁø, °ú°Å¿¡´Â N2 node¶ó°í ºÒ·¶´ø 7¹ø left gastric node¿Í 9¹ø celicac node±îÁö ¸²ÇÁÀý ÀüÀÌ°¡ ÀÖ¾ú½À´Ï´Ù.

ÀϺ» À§¾Ï °¡À̵å¶óÀÎ 4ÆÇ(2014)

µé¹®¾ÏÀº ³»½Ã°æ Áø´ÜÀÌ ¾î·Æ½À´Ï´Ù. ³õÄ¡±â ½±°í, ħÀ± ±íÀÌ (¼ÒÀ§ ½É´Þµµ) Áø´ÜÀÌ ¾î·Æ½À´Ï´Ù. ¸²ÇÁÀý ÀüÀ̵µ ¸¹Àº ÆíÀÔ´Ï´Ù. ÇÑ ¸¶µð·Î ¹«¼­¿î ¾ÏÀÔ´Ï´Ù. ÀÌ·± °üÁ¡¿¡¼­ óÀ½ ³»½Ã°æ »çÁøÀ» ´Ù½Ã Çѹø ÂùÂùÈ÷ µé¿©´Ù º¸¾Ò½À´Ï´Ù.

½Äµµ¿¡¼­ À§·Î µé¾î°¡´Â °úÁ¤¿¡ cardia¿¡ ¹º°¡ ÀÌ»óÀÌ ÀÖÀ½À» ¹ß°ßÇϼ̽À´Ï´Ù (5,6¹ø° »çÁø). À§¸¦ °ñ°í·ç °üÂûÇÑ ÈÄ retroflection »óÅ¿¡¼­ cardia¸¦ Æò°¡ÇÏ°íÀÚ ³ë·ÂÇϼ̴ø °Í °°Àºµ¥ ÁÁÀº »çÁøÀº ¾ø½À´Ï´Ù. ¾Æ¸¶ retreflectionÀ¸·Î Àß º¸±â ¾î·Á¿î º´¼Ò¿´´ø ¸ð¾çÀÔ´Ï´Ù. ³ª¿À¸é¼­ ´Ù½Ã °üÂûÇÏ°í (³ë¶õ»ö box) Á¶Á÷°Ë»ç¸¦ Çϼ̽À´Ï´Ù. ´Ù½Ã ºÁµµ ¸ÚÁø °Ë»çÀÔ´Ï´Ù. ³õÄ¡±â ½¬¿î µé¹®¾ÏÀ» Àß ¹ß°ßÇÏ°í Àß Æò°¡ÇØ Áּ̽À´Ï´Ù.

¿ä¾àÇÕ´Ï´Ù. µé¹®¾ÏÀº ¹ß°ßÀÌ ¾î·Æ°í, À°¾È¼Ò°ß¿¡ ºñÇÏ¿© ½ÉÇÑ °æ¿ì°¡ ´ëºÎºÐÀÔ´Ï´Ù. µé¹®¾Ï ¹ß°ßÀ» À§Çؼ­´Â ÁÁÀº ³»½Ã°æ ½À°üÀÌ ÇÊ¿äÇÕ´Ï´Ù. µé¹®(cardia)Àº µé¾î°¡¸é¼­ Àß º¸°í, retroflectionÇؼ­ ´Ù½Ã Çѹø Àß º¸°í, ³ª¿À¸é¼­µµ ¼¼¹ø°·Î Àß º¸´Â ½À°üÀÌ ÇÊ¿äÇÕ´Ï´Ù.


[More cases of GEJ cancer]

À§¾Ï. M/D adenocarcinoma, 0.7x0.6 cm, MM, LN (-) : ÁÖº¯¿¡ Barrett ½Äµµ°¡ ¾ø°í º´¸®ÇÐÀûÀ¸·Îµµ ¹Ù·¿½ÄµµÀÇ Áõ°Å°¡ ¾ø¾úÀ½. Áö±Ý±îÁö °æÇèÇÑ cardia cancer Áß °¡Àå ½Äµµ¾Ïó·³ »ý°å´ø °æ¿ìÀÓ.

À§¾Ï. Signet ring cell carcinoma, 1.5 cm, SM2 invasion, LN metastasis (+, 1/31)

À§¾Ï. W/D adenocarcinoma, 0.6x0.4cm, SM3, LN (-), Pre-existing adenoma with HGD (1.6x1.5cm). À§½ÄµµÁ¢ÇպξÏÀº »ý°¢º¸´Ù ½É´Þµµ°¡ ±íÀ» ¼ö ÀÖ½À´Ï´Ù.

½Äµµ¾Ï. Squamous cell carcinoma, 6x3 cm, perimuscular advantitia invasion, LN metastasis (+, 5/60)

Æó¾Ï°ú ½Äµµ dysplasia·Î ÀÇ·ÚµÈ ºÐÀÔ´Ï´Ù. Æó´Â stage IV adenocarcinoma·Î È®ÀεǾú½À´Ï´Ù. ½Äµµ´Â ÃÖ±Ù Á¶Á÷°Ë»ç Àü ¿ÜºÎ ³»½Ã°æ »çÁøÀ» ±¸ÇÒ ¼ö ¾ø¾î¼­ º» º´¿ø¿¡¼­ Àç°ËÇÑ »çÁøÀ» ¸ð¾Ò½À´Ï´Ù... ¿ª·ù¼º ½Äµµ¿° ¼Ò°ßÀ¸·Î º¸±â¿¡´Â °æ°è°¡ ºÒ±ÔÄ¢ÇÑ ¸ð¾çÀ̾ú½À´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­ squamous cell carcinoma (M/D)·Î È®ÀεǾú½À´Ï´Ù. ¼ö¼úÀû ÀýÁ¦°¡ ºÒ°¡´ÉÇÑ º´±âÀÇ Æó¾Ïµµ µ¿½Ã¿¡ ÀÖ¾ú±â ¶§¹®¿¡ ½Äµµ¿¡ ´ëÇÑ Ä¡·á °èȹÀº ÀâÁö ¸øÇÏ°í Æó¾Ï¿¡ ´ëÇÑ Ä¡·á¸¸ ½ÃÇàÇÏ¿´½À´Ï´Ù. ½Äµµ º´¼Ò¿¡ ´ëÇؼ­´Â Lugol spray, ESU µî Ãß°¡ Æò°¡°¡ ÇÊ¿äÇÏ°ÚÁö¸¸ Æó¾Ï¸¸ ¾ø¾ú´Ù¸é ESD¸¦ ½ÃÇàÇÒ ¼ö ÀÖÁö ¾Ê¾ÒÀ»±î »ý°¢µË´Ï´Ù.... ¿©ÇÏÆ° ½Äµµ¿¡ ´ëÇؼ­´Â Ãß°¡ °Ë»ç³ª Ä¡·á´Â ÇÒ ¼ö ¾ø¾ú½À´Ï´Ù.

½Äµµ¼±¾Ï (¹Ù·¿½Äµµ¾Ï). »ï¼º¼­¿ïº´¿ø Áõ·Ê¸¦ ¸ð¾Æ ÇÐȸ¿¡ ¹ßÇ¥ÇÑ °Í

(2016) Cardia À§¾ÏÀº ´Ã ¹«¼·½À´Ï´Ù. ÀÛÀº cardia À§¾ÏÀº ¹ß°ßµµ ¾î·Æ°í, Á¶Á÷°Ë»çµµ ½±Áö ¾Ê°í, »ý°¢º¸´Ù ½ÉÇÑ °æ¿ìµµ ÀÖ½À´Ï´Ù. ÁÂÃø ù »çÁøÀ» º¸¸é cardia À§¾ÏÀÌ ³»½Ã°æ »ðÀԺο¡ °¡·Á º¸ÀÌÁö ¾Ê½À´Ï´Ù. ¾à°£ ºñƲ¾î¾ß¸¸ º¸ÀÔ´Ï´Ù. ±íÁö ¾ÊÀº cardia À§¾ÏÀ̾úÁö¸¸, ù Áø´Ü ´ç½ÃºÎÅÍ perigastric node¿Í multiple hepatic metastasis°¡ ÀÖ¾ú½À´Ï´Ù. Cardia ÁÖº¯À» °üÂûÇÒ ¶§ ³»½Ã°æÀ» ³Ê¹« »¡¸® È×È× µ¹¸®Áö ¸»°í Á¶½É½º·´°Ô »ì»ì ºñƲ¸é¼­ µ¹·Á°¡¸ç °üÂûÇϸé ÁÁÀ» °Í °°½À´Ï´Ù.


[FAQ]

[2015-6-3. ¾Öµ¶ÀÚ Áú¹®]

GE junction cancer ·Î »ý°¢ÀÌ µå´Âµ¥, ½Äµµ¾ÏÀÎÁö À§¾ÏÀÎÁö ¾îµð·Î ±â¼úÀ» ÇØ¾ß ÇÒ±î °í¹ÎµÇ¾ú½À´Ï´Ù.

Ÿ¿ø Á¶Á÷°Ë»ç¿¡¼­ adenocarcinoma¿´´Ù´Â Á¡À» °í·ÁÇÒ ¶§ À§¾ÏÀÏ °¡´É¼ºÀÌ ³ôÀ» °Í °°°í »ý±ä ¸ð¾çµµ cardia ÂÊ¿¡¼­ ¹ß»ýÇÏ¿© ½ÄµµÂÊÀ¸·Î ¿Ã¶ó¿À´Â ¾ç»óÀ̶ó À§¾Ï, Áï cardia cancer·Î »ý°¢Çß½À´Ï´Ù. ÇÏÁö¸¸ ¿ì¸®³ª¶ó¿¡¼­ µå¹°´ÙÁö¸¸ BE ¿¡¼­ ¹ß»ýÇÏ´Â ½Äµµ¼±¾ÏÀÇ °¡´É¼ºÀº ¾øÀ»±î¿ä? GEJ cancer ¿¡ ´ëÇØ Esophageal, Cardial, Subcardia µîÀ¸·Î ³ª´©´Â ºÐ·ùµµ ÀÖ´øµ¥.. ±³¼ö´Ô²²¼± GEJ cancer ¸¦ ¾î¶»°Ô ºÐ·ùÇÏ°í °è½ÅÁö¿ä?

[2015-6-3. ÀÌÁØÇà ´äº¯]

¸Å¿ì ¾î·Á¿î Áú¹®ÀÔ´Ï´Ù. ÀÏ´Ü À§½ÄµµÁ¢ÇպξÏÀº Siewart ºÐ·ù¸¦ µû¸£´Â °ÍÀÌ º¸ÅëÀÔ´Ï´Ù. Á¾¾çÀÇ Áß½ÉÀÌ ¾îµð¿¡ À§Ä¡Çϴ°¡¸¦ ±âÁØÀ¸·Î ³ª´©´Â °ÍÀÔ´Ï´Ù. Type IÀº ´ëºÎºÐ ½Äµµ squamous cell carcinoma¾ÏÀÌ°í type III´Â ´ëºÎºÐ À§ adenocarcinomaÀÔ´Ï´Ù.


¹®Á¦´Â Siewert IIÀÔ´Ï´Ù. Squamous cell carcinoma·Î ³ª¿À¸é ±×³É ½Äµµ¾ÏÀ̶ó°í ºÎ¸£¸é ±×¸¸ÀÔ´Ï´Ù. ±×·±µ¥ adenocarcinoma·Î ³ª¿ÔÀ» ¶§, À§¼±¾ÏÀÎÁö ¹Ù·¿½Äµµ¼±¾ÏÀÎÁö ±¸ºÐÀÌ ¾î·Á¿ï ¼ö ÀÖ½À´Ï´Ù. ºóµµ´Â À§¼±¾ÏÀÌ ÈξÀ ¸¹½À´Ï´Ù. ±×·±µ¥ ÁÖº¯¿¡ ¹Ù·¿½Äµµ°¡ ÇöÀúÈ÷ ÀÖ°í ±× °¡¿îµ¥ ȤÀº ±×¿Í ¿¬ÇÏ¿© ¼±¾ÏÀÌ ÀÖ´Â °æ¿ì´Â ¹Ù·¿½Äµµ¾ÏÀÏ ¼ö ÀÖ½À´Ï´Ù. ESD ȤÀº ¼ö¼ú º´¸®¿¡¼­ ¼±¾Ï ¾Æ·¡ÂÊÀ» Àß º¸¾Æ¼­ ½Äµµ gland°¡ º¸Àδٰųª muscularis mucosa°¡ µÎ ÃþÀ¸·Î º¸Àδٰųª ÇÏ´Â µîÀÇ ÀÌÀ¯·Î À§Ä¡°¡ ½ÄµµÀÌ¸é ¹Ù·¿½Äµµ¾ÏÀ¸·Î º¸´Â °ÍÀÌ ÁÁ°í ±×·¸Áö ¾ÊÀ¸¸é À§¾ÏÀ¸·Î º¸¸é µÇ°Ú½À´Ï´Ù. ¾Æ·¡ »çÁøÀº ¾Æ»êº´¿ø Áõ·ÊÀε¥ ¼±¾Ï ¾Æ·¡ÂÊ¿¡ ¶Ñ·ÇÇÑ esophageal gland°¡ º¸¿© ¹Ù·¿½Äµµ¼±¾ÏÀ¸·Î Áø´ÜµÇ¾ú´ø °æ¿ìÀÔ´Ï´Ù.

ÀÌ¹Ì º´¸®°á°ú°¡ adenocarcinomaÀÎ °ÍÀ» ¾Ë°í ÀÖ´Â ÀÌ Áõ·Ê¸¦ À§¾ÏÀ¸·Î ºÙÀÌ´Â °ÍÀÌ ÁÁÀ»Áö, ½Äµµ¾ÏÀ¸·Î ºÙÀÌ´Â °ÍÀÌ ÁÁÀ»Áö »ý°¢ÇØ º¾´Ï´Ù. ºóµµ»ó À§¾ÏÀÌ ¸¹À¸¹Ç·Î cardia cancer¶ó°í ¾²¸é 90% ÀÌ»óÀº ¸ÂÀ» °Í °°½À´Ï´Ù. ÀÌ ¶ÇÇÑ ¾Ö¸ÅÇÏ´Ù°í »ý°¢µÇ¸é Â÷¶ó¸® Á߸³ÀûÀÎ ¿ë¾îÀÎ GE junction cancer¶ó°í ¾²¸é ÈìÀâÈú ÀÏÀÌ ¾ø½À´Ï´Ù. Á¾¾ç ÁÖº¯À¸·Î ¶Ñ·ÇÇÑ ¹Ù·¿½Äµµ°¡ ÀÖÀ¸¸é cardia cancer, r/o Barrett adenocarcinoma¶ó°í ºÙÀ̸é ÁÁ°ÚÁö¸¸ ÀÌ È¯ÀÚ¿¡¼­´Â ÁÖº¯¿¡ ¹Ù·¿½Äµµ´Â ¾ø±â ¶§¹®¿¡ ÇØ´çÇÏÁö ¾Ê°Ú½À´Ï´Ù.

Áú¹®¿¡ ´ëÇÑ °£´ÜÇÑ ´äº¯ÀÔ´Ï´Ù. Á¤¸» ¹Ù·¿½Äµµ¾Ï °°À¸¸é ¹Ù·¿½Äµµ¾ÏÀ̶ó°í ¾²°í ±×·¸Áö ¾ÊÀº ´ëºÎºÐÀº cardia cancer·Î ¾²¸é µË´Ï´Ù. ÃÖÁ¾ º´¸®¿¡¼­ ´äÀÌ ³ª¿É´Ï´Ù. ºÐ·ù´Â ¾²Áö ¾Ê¾Æµµ ÁÁ½À´Ï´Ù. ¾²°í ½Í´Ù¸é Siewert ºÐ·ù¸¦ »ç¿ëÇϽʽÿä.

ÀÌ·± Á¾¾ç¿¡¼­ °¡Àå Áß¿äÇÑ °ÍÀº 'Á¤¸» ¾ÏÀÌ ¸Â´Â°¡?'ÀÔ´Ï´Ù. Áï sentinel polyp°úÀÇ ±¸ºÐÀÔ´Ï´Ù. sentinel.html¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù.


[References]

1) EndoTODAY ¹Ù·¿½Äµµ

2) Japanese classification of esophageal cancer, 2017

3) EndoTODAY ½Äµµ¾Ï ȯÀÚÀÇ ¸²ÇÁÀý ¸í¸í¹ý

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