EndoTODAY | EndoATLAS | OPD

Parasite | Eso | Sto | Cancer | ESD

Boxim | DEX | Sono | Schedule

Home | Recent | Blog | Links

EndoTODAY ³»½Ã°æ ±³½Ç


[Ç×¹® Áúȯ. Anus] - ðû

È«¼º³ë ±³¼ö´Ô °­ÀÇ·Ï (³»½Ã°æ¼¼¹Ì³ª)

1. Ç×¹®ÀÇ ±¸Á¶

2. Anal fistula Ä¡·ç

3. Anal tag

4. Hemorrhoids Ä¡ÇÙ, Ä¡Áú

5. Anal varix in hepatic cirrhosis Ç×¹® Á¤¸Æ·ù

6. Anal melanoma Ç×¹® Èæ»öÁ¾

7. Condyloma acuminatum and other sexually trasmitted diseases

8. Anus involvement of rectal cancer Á÷Àå¾ÏÀÇ Ç×¹® ħÀ±

9. Anal cancer (squamous) Ç×¹®¾Ï

10. Anal adenocarcinoma Ç×¹® ¼±¾Ï

11. Hypertrophied anal papillae

12. Chlamydia proctitis Ŭ¶ó¹Ìµð¾Æ

13. Lymphoid hyperplasia of the rectum

14. Other diseases

15. FAQ

16. References


1. Ç×¹®ÀÇ ±¸Á¶ - 2017-6-5. ¿ù¿ä¼ÒÈ­±âÁý´ãȸ È«¼º³ë ±³¼ö´Ô °­ÀÇ

Ç×¹®ÀÇ ±¸Á¶´Â º¹ÀâÇÕ´Ï´Ù.

Anal canalÀº anal verge·ÎºÎÅÍ anorectal ring±îÁöÀÇ Á¼Àº ºÎÀ§ÀÔ´Ï´Ù. Anorectal ringÀº internal sphincter¿Í puburectalis muscleÀÇ »ó´ÜºÎÀÔ´Ï´Ù. Anorectal ringÀº Á÷Àå¼öÁö°Ë»ç·Î´Â ±¸ºÐÇÒ ¼ö ÀÖÀ¸³ª ³»½Ã°æÀ¸·Î´Â ±¸ºÐÇÒ ¼ö ¾ø½À´Ï´Ù.

Anal canalÀº anal verge·ÎºÎÅÍ rectum±îÁö 4cm (range: 3-5 cm) ±æÀÌÀÇ ±¸Á¶¹°ÀÔ´Ï´Ù. Perianal skinÀÇ squamous epitheliumÀº hair°¡ ÀÖ½À´Ï´Ù. Anoderm (= anal skin = modified squamous epithelium devoid of skin appendage)Àº hair°¡ ¾ø½À´Ï´Ù. AnodermÀº pale, smooth, shiny, hairless ÇÑ °ÍÀÌ Æ¯Â¡ÀÔ´Ï´Ù. Ç×¹®À» À°¾È°üÂûÇÒ ¶§ ¾à°£ ´ç°Üº¸¸é ±× Â÷ÀÌ°¡ È®¿¬ÇÕ´Ï´Ù. Perianal skin°ú anoderm (= anal skin)ÀÇ °æ°è°¡ anal vergeÀÔ´Ï´Ù. (È«¼º³ë ±³¼ö´Ô comment: Anal verge´Â hair¸¦ º¸¸é ¾Æ´Âµ¥ hair°¡ ÀÖ´Â squamous epithelium°ú hair and gland¿Í °°Àº skin appendage°¡ ¾ø´Âmodified squamous epithelium, ANODERM °æ°èÀÔ´Ï´Ù.)

Dentate line (= pectinate line)Àº anal canal ³»ºÎ¿¡¼­ ¼­·Î ´Ù¸¥ µÎ Á¡¸·ÀÌ ¸¸³ª´Â °æ°èÀÔ´Ï´Ù. ½Å°æ, Ç÷¾× °ø±Þ, ¸²ÇÁ drainge µîÀÌ dentate lineÀ» °æ°è·Î ´Þ¶óÁý´Ï´Ù. (È«¼º³ë ±³¼ö´Ô comment: Dentate line (= pectinate line)Àº anal canal ³»ºÎ¿¡¼­ ¼­·Î ´Ù¸¥ µÎ Á¡¸·ÀÌ ¸¸³ª´Â °æ°èÀÔ´Ï´Ù. ½Å°æ, Ç÷¾× °ø±Þ, ¸²ÇÁ drainge µîÀÌ dentate lineÀ» °æ°è·Î ´Þ¶óÁý´Ï´Ù.)

Dentate line (= pectinate line)À» Á÷Àå¿¡¼­ retroflection Çؼ­ º» ¸ð½À.

Dentate lineÀÇ upper part¿¡´Â 6-10°³ÀÇ longitudinal fold of Morgagni°¡ ÀÖ½À´Ï´Ù. Morgagni column »çÀÌ¿¡ anal gland°¡ openingÇÏ´Â anal crypt (= anal sinus)°¡ ÀÖ½À´Ï´Ù. (È«¼º³ë ±³¼ö´Ô comment: Dentate line¸¦ º¸¸é °ñÂ¥±â¿Í ¾ð´öÀÌ Àִµ¥ ¡¦ °ñÂ¥±â´Â anal crypt, ¾ð´öÀº anal papillae ¶ó°í ÇÕ´Ï´Ù. )

Anal crypt (= anal sinus)¿¡ infectionÀÌ µÇ¸é anal abscess¿Í ÁøÇàµÇ¸é fistula¸¦ Çü¼ºÇÏ°Ô µË´Ï´Ù.

Transitional zoneÀº squamous epitheliumÀÌ Á¡ÁøÀûÀ¸·Î cuboidal epitheliumÀ» °ÅÃÄ columnar epitheliumÀ¸·Î ÀÌÇàÇÏ´Â ºÎºÐÀÔ´Ï´Ù. Áï, tranzitional zoneÀº dentate lineÀ¸·ÎºÎÅÍ ¸í¹éÇÑ columnar epithelium ±îÁöÀÇ Áß°£ Á¡¸·ÀÔ´Ï´Ù.

Anorectal ring (Èò»ö Á¡¼±)Àº internal sphincter¿Í puburectalis muscleÀÇ »ó´ÜºÎ·Î Á÷Àå¼öÁö°Ë»ç·Î´Â ±¸ºÐÇÒ ¼ö ÀÖÀ¸³ª ³»½Ã°æÀ¸·Î´Â ±¸ºÐÇÒ ¼ö ¾ø½À´Ï´Ù. Anorectal ring ÁÖÀ§ÀÇ Á¡¸·ÀÌ ¸ðµÎ columnar epitheliumÀ̱⠶§¹®ÀÔ´Ï´Ù. ÁÖº¯ ±ÙÀ°À¸·Î ÀÎÇÑ °¢µµÀÇ º¯È­´Â ÀÖÀ¸³ª Ç¥¸éÀº ´Ù¸£Áö ¾Ê±â ¶§¹®ÀÔ´Ï´Ù. Dentate lineºÎÅÍ anarectal ring (= anal canalÀÇ »ó´Ü)ÀÇ Á¡¸·Àº ´ë°­ Àý¹ÝÀº transitional zone (double white arrow)ÀÌ°í Àý¹ÝÀº columar epitheliumÀÔ´Ï´Ù. ÀÌ Á¼Àº ¿µ¿ªÀÇ ¾ÏÀÌ ¹ß»ýÇÏ¸é ³»½Ã°æÀûÀ¸·Î´Â anal canal cancer¶ó°í ºÒ·¯¾ß ÇÕ´Ï´Ù (³»½Ã°æÀ¸·Î °üÂûÇÒ ¶§ Á¾¾çÀÇ epicenter°¡ dentate line 2 cm À̳»¿¡ Á¸ÀçÇÑ´Ù¸é). Á¶Á÷°Ë»ç °á°ú squamous carcinoma (transitional cell carcinoma Æ÷ÇÔ)´Â CCRT¸¦, adenocarcinomaÀÇ °æ¿ì abdominoperineal resection (Miles operation) Áß½ÉÀÇ Ä¡·á°¡ ÇÊ¿äÇÕ´Ï´Ù.

Anal cancer¿Í rectal cancerÀÇ ±¸ºÐÀº trickyÇÕ´Ï´Ù. Epicenter (º´º¯ÀÇ Áß¾Ó) À§Ä¡¿¡ µû¶ó ±¸ºÐÇÒ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.

È«¼º³ë ±³¼ö´ÔÀÇ °­ÀÇ¿¡¼­ ¹è¿î °ÍÀ» ¹ÙÅÁÀ¸·Î Á¦°¡ Á¤¸®ÇÑ ±×¸²ÀÔ´Ï´Ù.

Esophago-gastric junction¿¡¼­´Â anatomical °æ°è¿Í histological °æ°è°¡ °ÅÀÇ ÀÏÄ¡ÇÏ´Â ¹Ý¸é, ano-rectal junction¿¡¼­´Â anatomical °æ°è°ú histological °æ°è°¡ ´Þ¶ó¼­ °³³äÀ» Àß Àâ¾ÆµÎ¾î¾ß ÇÒ °Í °°½À´Ï´Ù.

Anorectal line (yellow line)Àº Á¶Á÷ÇÐÀûÀ¸·Î °áÁ¤µÇ´Â columnar mucosa¿Í transitional zone (white arrow)ÀÇ °æ°èÀÔ´Ï´Ù. Anal canalÀÇ upper limit, Áï anorectal ring (Áï anus¿Í rectumÀÇ °æ°è, blue line Á¤µµ¿¡ À§Ä¡)Àº ÇغÎÇÐÀûÀ¸·Î °áÁ¤µÇ´Â puburectalis muscleÀÇ »ó´ÜÀÔ´Ï´Ù (¾Æ·¡ ±×¸² ÂüÁ¶). Anorectal ringÀº Á÷Àå¼öÁö°Ë»ç¸¦ ÅëÇÏ¿© ȯÀÚ¿¡°Ô ÈûÀ» ÁÖ¶ó°í ÇßÀ» ¶§ ¸¸Á®Áö´Â ´Ü´ÜÇÑ ºÎÀ§ÀÇ »ó´ÜÀÔ´Ï´Ù. ³»½Ã°æÀ¸·Î º¼ ¼ö ÀÖ´Â °ÍÀº anorectal line (yellow line)ÀÌÁö anorectal ring (blue line Á¤µµ¿¡ À§Ä¡)Àº ¾Æ´Õ´Ï´Ù. Anorectal ring (blue line Á¤µµ¿¡ À§Ä¡)Àº dentate line (white line)º¸´Ù ¾à 2cm »ó¹æÀÌ°í anorectal line (yellow line)º¸´Ù ¾à 1cm »ó¹æÀÔ´Ï´Ù.

Left lateral·Î °Ë»ç¸¦ Çϸé Á÷Àå¿¡¼­ÀÇ ¹æÇâ °ü°è´Â ÀÌ¿Í °°½À´Ï´Ù.

¹Ù·Î ´©¿ì¸é Á÷Àå¿¡¼­ÀÇ ¹æÇâ °ü°è´Â ÀÌ¿Í °°½À´Ï´Ù.


2. Anal fistula

ÀÚ·á Á¦°ø: Ãֿ뼺

The four main anatomic types of fistulas. The external sphincter mass is regarded as the keystone, and the prefixes trans, supra, and extra refer to it. The puborectalis muscle has been crosshatched for easy recognition. Type 1, intersphincteric; type 2, trans-sphincteric; type 3, suprasphincteric; type 4, extrasphincteric

Æò¼Ò Ç×¹®À» ÅëÇÑ ºÐºñ¹°. ÀÚ·á Á¦°ø: Ãֿ뼺

More cases of anal fistula. ÀÚ·á Á¦°ø: Ãֿ뼺

º¸ÅëÀÇ anal fissure´Â 6½Ã ¹æÇâ¿¡¼­ ¹ß»ýÇÕ´Ï´Ù. ´Ù¸¥ ¹æÇâ¿¡¼­ ¹ß»ýÇϸé Crohn º´ µîÀ» ÀǽÉÇغ¸¾Æ¾ß ÇÕ´Ï´Ù. ¿ì¸®³ª¶ó Crohn º´ ȯÀÚ¿¡¼­´Â perianal fistula, abscess°¡ ¸¹½À´Ï´Ù. ÀþÀº »ç¶÷ÀÌ perianal discomfort¸¦ È£¼ÒÇϸé ÇѹøÂë Å©·Ðº´À» ÀǽÉÇØ º¸´Â °ÍÀÌ ÁÁ½À´Ï´Ù.


[2021-1-18. ¾Öµ¶ÀÚ ÆíÁö]

³»°ú °è¿­ ¼±»ý´Ôµé¿¡°Ô´Â ³¸¼± anorectal type IVÀÔ´Ï´Ù. ÀÌ È¯ÀÚ´Â °í¸§ÀÌ Á¶±Ý¾¿ ÅÍÁ® ³ª¿Â °ü°è·Î ÅëÁõÀÌ ÁÙ¾îµç »óÅ¿¡¼­ ´ëÀå°æ °Ë»ç¸¦ ¹ÞÀ¸¼Ì½À´Ï´Ù. Áõ»óÀº Ç×¹®ÀÌ ¾à°£ ¾ÆÇ Á¤µµ¿´À¸¹Ç·Î °ËÁø³»½Ã°æÀ» ¹ÞÀ¸¼Ì½À´Ï´Ù.

Ä¡·á´Â ÀÌ¹Ì ÅÍÁ³±â¿¡ ÀúÀý·Î ÁÁ¾ÆÁý´Ï´Ù. ¸¸¾à ÅÍÁöÁö ¾ÊÀ¸¸é Ç×¹® ¿Ü°ú¿¡¼­ ôÃ߸¶ÃëÇÏ¿¡ ¾ÈÂÊÀ» ÅͶ߸³´Ï´Ù.

¾Æ·¡´Â Ç×¹® ³ó¾çÀÌ Ä¡·ç·Î º¯½ÅÇÏ´Â ´Ü°è¸¦ º¸¿©ÁÖ°í ÀÖ½À´Ï´Ù.

[2021-1-18. ÀÌÁØÇà ´äº¯]

°¨»çÇÕ´Ï´Ù. Anorectal fistula ºÐ·ù ±×¸²À» ã¾Æº¸¾Ò½À´Ï´Ù.


3. Anal tag

ÀÚ·á Á¦°ø: ±èÅÂÁØ


4. Hemorrhoids. Ä¡ÇÙ

¿ÜÄ¡ÇÙÀº Ä¡»ó¼± ¹Ù±ùÂÊ¿¡ Çü¼ºµÈ Ä¡ÇÙÀ¸·Î Ç×¹® ÁÖÀ§¿¡¼­ º¸À̸ç Ç÷ÀüÀÌ ¹ß»ýÇÏ°Ô µÇ¸é ½ÉÇÑ ÅëÁõÀÌ À¯¹ßµÇ´Â Ư¡ÀÌ ÀÖ½À´Ï´Ù. ¿ÜÄ¡ÇÙÀº Ç÷°üÈ®ÀåÀ¸·Î ÇǺΠ´Ã¾îÁü(ÇǺβ¿¸®), ¹Ýº¹µÈ Ç÷ÀüÀÌ Çü¼ºµÇ°í ±×·Î ÀÎÇØ ÅëÁõÀÌ ¹ß»ýµË´Ï´Ù. Ç÷ÀüÀº Äá¾Ë°°Àº µ¢¾î¸®·Î ¸¸Á®Áú ¼ö ÀÖ½À´Ï´Ù.

´ëÀå³»½Ã°æ¿¡¼­ prolapsed internal hemorrhoid¿Í external hemorrhoidÀÇ ±¸ºÐÀÌ ¾î·Á¿ï ¼ö ÀÖ½À´Ï´Ù. ³»Ä¡ÇÙÀº ÃâÇ÷°ú Æ¢¾î³ª¿Â µ¢¾î¸®°¡ ÁÖ Áõ»óÀÌ°í ¿ÜÄ¡ÇÙÀº ÅëÁõÀÌ ÁÖ Áõ»óÀÔ´Ï´Ù. ³»Ä¡ÇÙÀº ÁÖ·Î Ç÷°ü ¼ººÐ, ¿ÜÄ¡ÇÙÀº ÁÖ·Î »ìÁ¡ ¼ººÐÀ¸·Î ¼³¸íÇÏ´Â ºÐµµ °è½Ê´Ï´Ù. ÃâÇ÷·Î ½ÃÇàÇÑ ´ëÀå³»½Ã°æ¿¡¼­ Ç×¹® ¹Ù±ù¿¡ º¸ÀÌ´Â °ÍÀº ÁÖ·Î prolapsed internal hemorrhoidÀÔ´Ï´Ù.

Prolapsed internal hemorrhoids. M/60 (2022)

* Âü°í: ¹Î¿µÀÏ ±³¼ö´Ô - Naver Blog Ä¡ÇÙ ¼³¸í


5. Anal varix in hepatic cirrhosis

In the lower GI tract, collaterals between the superior hemorrhoidal vein (portal) and the middle and inferior hemorrhoidal veins (systemic) result in anal and rectal varices. Hemorrhoids must be differentiated from anal varices; the former appear as purple, well-vascularized mucosa in the lower 4 cm of the anal canal. Varices in the anal canal appear as either discrete vein or saccular blue or slate grey swellings. Rectal varicex start above the pectinate line and are easy to diagnose. [Ginsberg textbook 2005]

a fatal case


6. Anal melanoma

Ç×¹®Á÷ÀåÀÇ Èæ»öÁ¾Àº ½Åü ¸ðµç ºÎÀ§¿¡ ¹ß»ýÇÏ´Â Èæ»öÁ¾ÀÇ 1%¸¦ Â÷ÁöÇϸç ÇÇºÎ¿Í ´« ´ÙÀ½À¸·Î ÈçÇÏ´Ù. Ç×¹® Á÷Àå¿¡¼­ ¹ß»ýÇÏ´Â ´Ù¸¥ Á¾¾ç°úÀÇ »ó´ëÀû ¹ß»ý·ü¿¡¼­ ¼±¾Ï´ë Èæ»öÁ¾ÀÇ ºñÀ²ÀÌ 250:1Á¤µµ·Î ¾Ë·ÁÁ® ÀÖ´Ù. Ç×¹®Á÷ÀåÈæ»ýÁ¾ÀÇ 90% ÀÌ»óÀÌ Ç×¹®ÀÇ Ä¡»ó¼±¿¡¼­ ¹ß»ýÇÏÁö¸¸, ¿ø¹ß¼º Èæ»öÁ¾ÀÌ Ä¡»ó¼± »ó¹æÀÇ Á÷ÀåÀ̳ª S-»ó °áÀå¿¡¼­µµ µå¹°°Ô ¹ß»ýÇÑ´Ù. ³»½Ã°æ¿¡¼­ black pigmentationÀ» º¸ÀÌÁö ¾Ê´Â °æ¿ì°¡ ¸¹´Ù.

°¡Àå ÈçÇÑ Áõ»óÀº Ç×¹®Á÷Àå ÃâÇ÷Àε¥ hemorrhoid¿Í È¥µ¿µÇ´Â ¼ö°¡ ¸¹´Ù. Ç×¹®Á÷ÀåÀÇ Èæ»öÁ¾Àº ¸Å¿ì aggressiveÇÑ ÁúȯÀ¸·Î Á¾±«°¡ À۾Ƶµ ¸²ÇÁÀýÀ» ÅëÇÏ¿© ÀüÀÌµÉ »Ó ¾Æ´Ï¶ó Ç÷¾×À» µû¶ó¼­ Æó, °£, ³ú, °ñ°Ý µî¿¡ ½±°Ô ÀüÀ̵ȴÙ. ÃÖ±Ù ¼ÒÈ­±â³»½Ã°æÇÐȸÁö¿¡´Â Ç×¹®¿¡¼­ ¹ß»ýÇÑ Èæ»öÁ¾ÀÌ 5 cm Á¤µµ ¶³¾îÁø Á÷ÀåÀÇ Á¡¸·ÇÏ·Î ÀüÀÌµÈ Áõ·Ê°¡ º¸°íµÈ ¹Ù ÀÖ´Ù (´ëÇѼÒÈ­±â³»½Ã°æÇÐȸÁö 2008;37:299-302). Ä¡·á·Î¼­´Â ±¤¹üÀ§ÇÑ ¼ö¼úÀÌ ÃßõµÇÁö¸¸, Æò±Õ »ýÁ¸±â°£ÀÌ 2³â Á¤µµÀ̸ç 5³â »ýÁ¸À²µµ 6%¿¡ ºÒ°úÇÏ´Ù. [2009-3-9. ÀÌÁØÇà]


Rectum, abdominoperineal resection: Malignant melanoma (see note)
1. Location: rectum
2. Gross type: ulceroinfiltrative
3. Size: 6.5x5.5 cm
4. Depth of invasion: invades perirectal adipose tissue and external sphincter muscle
5. Resection margin: free from carcinoma, safety margin: proximal, 11.5 cm ; distal, 30 cm ; circumferential(radial), less than 1 mm
6. Regional lymph node metastasis : Metastasis to 2 out of 31 regional lymph nodes
7. Lymphatic invasion: not identified
8. Venous invasion: present(intramural)
9. Perineural invasion: not identified
10. Tumor budding : negative
11. Micropapillary component: no
12. Tumor border: pushing
13. Separate lesions: hyperplastic polyp (0.2x0.2 cm)
Note: There is no AJCC staging criteria for gastrointestinal melanoma.

Anal melanoma recurrence with gastric metastasis

Anal melanoma·Î transanal resection ÈÄ recurÇÏ¿© Miles' op ÇÏ¿´À¸³ª ´Ù½Ã Àç¹ß ÈÄ multiple metastasis¸¦ º¸ÀÓ. (2016-12-13. ³»½Ã°æÇÐȸ Áý´ãȸ. ¹ÚÀç¿ë)


7. Condyloma acuminatum & Sexually transmitted anorectal lesions

Anal pain and rectal bleeding during defecation. ÀÚ·á Á¦°ø: Ãֿ뼺

ÀÚ·á Á¦°ø: Ãֿ뼺

Ä¡·á ÈÄ Àç¹ßÀÌ ¸¹¾Æ¼­ °¡´Ù½Ç µî ¿¹¹æÁֻ縦 ±ÇÇÕ´Ï´Ù. (Á¦1ȸ »ï¼º¼­¿ïº´¿ø ¿Ü°ú ½ÉÆ÷Áö¾ö. ¼öÁö À¯¿£Ç׿ܰú ÀÌ·çÁö)

2016 ¿¬¼¼´ëÇб³ ÀÇ°ú´ëÇÐ ¼ÒÈ­±âÇÐ ¿¬¼ö°­ÁÂ. ¹Ú¼öÁ¤


[Sexually transmitted anorectal lesions]

ÀÚ·á Á¦°ø: Ãֿ뼺

ÀÚ·á Á¦°ø: Ãֿ뼺

ÀÚ·á Á¦°ø: Ãֿ뼺


8. Á÷Àå¾ÏÀÇ Ç×¹® ħÀ±

50´ë ³²¼ºÀÔ´Ï´Ù. °Ç°­°ËÁø ´ëÀå³»½Ã°æÀ̾ú½À´Ï´Ù. Ç×¹®ÀÇ chronic prolapsed lesionÀÌ ÀÖ¾î Á¶Á÷°Ë»ç¸¦ ÇÏ¿© adenocarcinoma°¡ ³ª¿Ô½À´Ï´Ù. (ColonTODAY 019)
Rectum, Miles' operation:
. Signet-ring cell carcinoma with mucin production ;
1. Location: rectum
2. Gross type: fungating
3. Size: 5x4 cm
4. Depth of invasion: invades perirectal adipose tissue(pT3)
5. Resection margin: free from carcinoma, safety margin: proximal, 20 cm ; distal, 2 cm ; radial, 4 mm
6. Regional lymph node metastasis : Metastasis to 9 out of 25 regional lymph nodes(pN2b), (9/25: perirectal, 9/25; "IMA LN", 0/4)
7. Lymphatic invasion: present (+++)
8. Venous invasion: present(intramural)
9. Perineural invasion: present(intramural)
10. Tumor budding : negative
11. Micropapillary component: no
12. Tumor border: infiltrative
13. Pathologic staging: pT3 N2b


9. Anal cancer Ç×¹®¾Ï

Anal cancer = anal canal cancer + anal marginc cancer

Dentate lineº¸´Ù 2cm ¹Ì¸¸¿¡ epicenter°¡ ÀÖÀ¸¸é anal cancer cancer·Î ºÐ·ùÇÕ´Ï´Ù. Anal canalÀÇ upper margin (puborectalis muscleÀÇ upper margin) Àº ³»½Ã°æÀ¸·Î ±¸ºÐÇÒ ¼ö ¾ø±â ¶§¹®ÀÔ´Ï´Ù. Anorectal line (columnar-transitonal zone °æ°è)°¡ anorectal ringÀÌ ´Ù¸£±â ¶§¹®ÀÔ´Ï´Ù.


10. Anal adenocarcinoma Ç×¹®¼±¾Ï

biopsy: adenocarcionma

Stool occult blood ¾ç¼ºÀ¸·Î ½ÃÇàÇÑ ´ëÀå³»½Ã°æ¿¡¼­ ¾Æ·¡ º´¼Ò°¡ ¹ß°ßµÇ¾ú½À´Ï´Ù. ¾î¶»°Ô »ý°¢ÇϽʴϱî?

.

.

Á¶Á÷°Ë»ç »ó adenocarcinoma·Î ³ª¿Ô°í ¿Ü°ú¿¡¼­ transanal endoscopic resectionÀ» ÇÏ¿´½À´Ï´Ù. ºñ·Ï º´¸®¿¡¼­ ¾Æ·¡¿Í °°ÀÌ °á°ú¸¦ ÁÖ¾úÁö¸¸ º´¼ÒÀÇ À§Ä¡´Â anusÀÌ°í anal adenocarcinoma·Î º¸´Â °ÍÀÌ Å¸´çÇÒ °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù.

Rectum, transanal rectal excision:
. Adenocarcinoma, well differentiated
1) Location: rectum
2) Gross type: polypoid
3) Size: 2.3x1.2cm
4) Depth of invasion: invades submucosa (pT1) (depth of invasion: 500§­ (0.5mm))
5) Resection margin: free from carcinoma, (safety margin: lateral, 0.2cm; deep, 0.1cm)
6) Lymphatic invasion: absent
7) Venous invasion: absent
8) Perineural invasion: absent
9) Tumor budding: no
10) Micropapillary component: no

2017³â 6¿ù 5ÀÏ ¿ù¿ä¼ÒÈ­±âÁý´ãȸ¿¡¼­ È«¼º³ë ±³¼ö´Ô²²¼­ anus¿¡ ´ëÇÏ¿© »ó¼¼È÷ ¼³¸íÇØ ÁֽŠ°Í Áß ÀϺθ¦ ¿Å±é´Ï´Ù.

Ç×¹®ÀÇ ±¸Á¶´Â º¹ÀâÇÕ´Ï´Ù.

Anal canalÀº anal verge·ÎºÎÅÍ anorectal ring±îÁöÀÇ Á¼Àº ºÎÀ§ÀÔ´Ï´Ù. Anorectal ringÀº internal sphincter¿Í puburectalis muscleÀÇ »ó´ÜºÎÀÔ´Ï´Ù. Anorectal ringÀº Á÷Àå¼öÁö°Ë»ç·Î´Â ±¸ºÐÇÒ ¼ö ÀÖÀ¸³ª ³»½Ã°æÀ¸·Î´Â ±¸ºÐÇÒ ¼ö ¾ø½À´Ï´Ù.


11. Hypertrophied anal papillae

Hemorrhoid¿Í µ¿¹ÝµÈ °æ¿ì

È«¼º³ë ±³¼ö´Ô °­ÀÇ·Ï (³»½Ã°æ¼¼¹Ì³ª)


12. Chlamydia proctitis

1°³¿ù ÀüºÎÅÍ »ý±ä ÀæÀº ¹èº¯°ú ¹èº¯½Ã¿Í ÈÄÀÇ ÃâÇ÷Áõ»ó (¾Öµ¶ÀÚ Áõ·Ê ÆíÁö 32)

ÀÇ»ç ½Å¹® 2011

ÀÇ»ç ½Å¹® 2011

30´ë ¿©¼º. ÇÑ ´Þ ÀüºÎÅÍ º¯À» º¼ ¶§ ÇϾá»öÀÇ Á¡¾×ÀÌ ¼¯¿© ³ª¿È. ºÎÀΰú¿¡¼­ °ñ¹Ý¿° Ä¡·á º´·Â (+). Doxycycline 200 mg x 7 days Åõ¾à ÈÄ È£ÀüµÇ¾úÀ½ (¾Öµ¶ÀÚ Áõ·Ê ÆíÁö 19)


13. Lymphoid hyperplasia of the rectum

Á÷ÀåÀÇ lymphoid hyperplasia´Â ´Ùµé ºñ½ÁÇØ º¸ÀÌÁö¸¸ ¾Æ·¡¿Í °°Àº °ÍµéÀ» °¨º°ÇØ¾ß ÇÒ °Í °°½À´Ï´Ù. »ó¼¼ÇÑ º´·ÂûÃë¿Í ÀÇ»çÀÇ °¨(Êï)ÀÌ Áß¿äÇÕ´Ï´Ù.

»ï¼º¼­¿ïº´¿ø ±èÀº¶õ ±³¼ö´Ô²²¼­ ºÐ¼®ÇÑ ¹Ù¿¡ ÀÇÇϸé nodular typeÀ̳ª SMT-like typeÀº ulcerative colitis³ª MALT lymphoma·Î Áø´ÜµÉ ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù (Gut Liver 2021).


14. Others

Lung cancer with anal metastasis. Biopsy: rectal mucosa showing adenocarcinoma (M/D), EGFR: positive (1+, 1%), BFAR: not detected. Lung cancer with multiple metastasis°¡ ÀÖ´ø ºÐÀ¸·Î anal lesion¿¡ ´ëÇؼ­´Â local RT¸¦ Ãß°¡ÇÏ¿´½À´Ï´Ù.

ÀÚ·á Á¦°ø: ±èÅÂÁØ

ÀÚ·á Á¦°ø: ±èÅÂÁØ

±¸´õ±â. ¼úÀ» Áñ°Ü µå½Ã´Â °íÇ÷¾Ð, ´ç´¢º´À» °¡Áø µ¶°Å³ëÀÎÀ¸·Î ¼Òº¯/´ëº¯ ½Ç±ÝÇÑä ÀǽÄÀÒ°í ¾²·¯Áø »óÅ·Π¹ß°ßµÇ¾ú½À´Ï´Ù. ÀÏÁÖÀÏ Àü ¸¶Áö¸·À¸·Î °¡Á·°ú ¿¬¶ôÀÌ ÀÖ¾ú´Âµ¥, Á¤È²À¸·Î º¸¾Æ 3-4ÀÏ Á¤µµ ¾²·¯Á® °è½Å °ÍÀ¸·Î ÃßÁ¤µÇ¾ú½À´Ï´Ù. ¹ß°ß ´ç½Ã ȯÀÚ ÁÖº¯¿¡ Æĸ®°¡ µé²ú°í ÀÖ¾úÀ¸¸ç, ´ëº¯¿¡ °ËºÓÀº»öÀ¸·Î hematochezia°¡ ¼¯¿© ÀÖ¾ú½À´Ï´Ù. ÀÔ¿øÈÄ¿¡µµ ÇÑÂ÷·Ê 300cc°¡·®ÀÇ hematochezia°¡ ÀÖ¾ú½À´Ï´Ù. ³»¿ø ´ç½Ã BST high, ABGA 7.355-21.5-112.8-10.9-98.1%, Ketone body (+), Osm 399·Î DKA + HHS ¿¡ ÀÇÇÑ ÀÇ½Ä ¼Ò½ÇÀ̾úÀ» °ÍÀ¸·Î »ý°¢µÇ¾úÀ¸¸ç, BUN/Cr 247.5/3.65 (FeNa 0.2%)·Î dehydration ¿¡ ÀÇÇÑ AKI¿Í azotemiaµµ ÀÖ¾ú½À´Ï´Ù. Hydration, insulin Åõ¿© µîÀ¸·Î ȸº¹µÇ´Â Ãß¼¼¿´½À´Ï´Ù. ¾î´À ¾Æħ ¸¹Àº ¹ú·¹°¡ Ç×¹®À¸·Î ³ª¿À´Â ¸ð½ÀÀÌ °üÂûµÇ¾ú½À´Ï´Ù. (EndoTODAY ±¸´õ±â)

Triamcinolone + lidocaine + indigocarmine + N/S subcutanesou injectionÀ» »ç¿ëÇϱ⵵ ÇÕ´Ï´Ù. (Á¦1ȸ »ï¼º¼­¿ïº´¿ø ¿Ü°ú ½ÉÆ÷Áö¾ö. ¼öÁö À¯¿£Ç׿ܰú ÀÌ·çÁö)

Biopsy: crypt epithelial hyperplasia


[FAQ]

[2017-6-30. ¾Öµ¶ÀÚ Áú¹®]

¾È³çÇϼ¼¿ä? °Ç°­°ËÁø ¼¾ÅÍ ³»½Ã°æ½Ç¿¡¼­ ±Ù¹«ÇÏ°í ÀÖ´Â ºÀÁ÷ÀÇÀÔ´Ï´Ù. Ç×»ó EndoTODAY¸¦ º¸¸é¼­ ´ëÇк´¿øÀ» ¶°³ª À־ ÀÌ·± ¾çÁúÀÇ ±³À°À» ¹ÞÀ» ¼ö ÀÖ´Â °Í¿¡ ´ëÇØ ±³¼ö´Ô²² °¨»çÇÏ°í ÀÖ½À´Ï´Ù. Á¤¸» Á¸°æÇÕ´Ï´Ù.

¿À´Ã º¸³»ÁֽŠ'Anus¿¡ °üÇÏ¿©'µµ ´ëÀå³»½Ã°æÀ» Çϸ鼭 Ç×»ó ±Ã±ÝÇØÇÏ´ø ÁÖÁ¦Àε¥ Á¤¸» À¯ÀÍÇß½À´Ï´Ù. ´ëÀå³»½Ã°æÀ» ÇÏ´Ù º¸¸é Ç×¹® ±Ùó¿¡ º´º¯À» ¹ß°ßÇÒ ¶§ polyp, skin tag, hemorrhoid Áß¿¡ Çò°¥¸®´Â °æ¿ì°¡ Á¾Á¾ ÀÖ½À´Ï´Ù. ÃâÇ÷ À§Çè ¶§¹®¿¡ biopsyµµ ²¨¸®°Ô µÇ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ¶Ç anal fissure³ª fistula µî¿¡ °üÇؼ­µµ ±Ã±ÝÇÑ Á¡ÀÌ ¸¹Àºµ¥ ³»½Ã°æ ¼­Àû¿¡¼­´Â anusÀÇ º´º¯Àº ¼ÒȦÇÏ°Ô ´Ù·ç´Â ºÎºÐÀÌ ¾Æ´Ñ°¡ ½Í½À´Ï´Ù. ¾ðÁ¦ ±âȸ°¡ µÇ½Ã¸é 'AnusÀÇ º´º¯¿¡ °üÇÏ¿©'µµ ÇÑ ¹ø ´Ù·ç¾î ÁÖ½Ã±æ ºÎŹµå¸³´Ï´Ù.

´õ¿îµ¥ °Ç°­ÇÏ½Ã°í ¿À´Ã ÇÏ·çµµ ÁÁÀº ÇÏ·ç µÇ½Ã±â¸¦ ¹Ù¶ø´Ï´Ù.

°¨»çÇÕ´Ï´Ù.

[2017-6-23. ÀÌÁØÇà ´äº¯]

ÁÁÀº ¸»¾¸ °¨»çÇÕ´Ï´Ù. ±×·¸½À´Ï´Ù. Áß¿äÇÑ °Í¸¸ ´Ù·ç°í Áß¿äÇÏÁö ¾Ê´Â °ÍÀº ¹«½ÃÇÏ´Â °ÍÀÌ ±³°ú¼­ ÁýÇÊÀÚÀÇ ÅµµÀÎ °Í °°½À´Ï´Ù. ±×·¯³ª ½ÇÀü¿¡¼­´Â »ç¼ÒÇÑ °ÍµéÀÌ Áß¿äÇÒ ¼ö ÀÖ½À´Ï´Ù. EndoTODAY´Â »ç¼ÒÇÑ °Íµµ ¼ÒÁßÈ÷ ´Ù·ì´Ï´Ù.

»ç½Ç »ç¼ÒÇÑ °ÍÀÌ ±³°ú¼­¿¡¼­ Àß ´Ù·ïÁöÁö ¾Ê´Â ÀÌÀ¯ Áß Çϳª´Â... ±³°ú¼­¿¡¼­ ¹è¿ì´Â °ÍÀÌ ¾Æ´Ï¶ó µµÁ¦±³À°À¸·Î ¹è¿ì´Â °ÍÀÌ´Ù°í »ý°¢ÇÏ´Â ºÐµéÀÌ ¸¹±â ¶§¹®ÀÔ´Ï´Ù. ³»½Ã°æ °í¼ö¸¦ 1-2³â µû¶ó´Ù´Ï¸é¼­ Ãæ½ÇÇÑ µµÁ¦±³À°À» ¹ÞÀ¸¸é »ç¼ÒÇÑ °Íµéµµ ¾î´À Á¤µµ Àͼ÷ÇØÁö±â ¸¶·ÃÀÔ´Ï´Ù. ±×·¯³ª ¿ì¸®³ª¶ó »çÁ¤ÀÌ ¾îµð ±×·¸½À´Ï±î?

»ç¼ÒÇÑ ¼Ò°ß¿¡ ´ëÇÑ ±³À° ¶ÇÇÑ Á¤»óÈ­µÇ¾úÀ¸¸é ÁÁ°Ú½À´Ï´Ù.


[2018-5-4. ¾Öµ¶ÀÚ Áú¹®]

Skin tag¿Í hypertrophied papillae´Â ¾î¶»°Ô ´Ù¸¥ °ÍÀΰ¡¿ä? À§Ä¡ÀÎÁö ¼¼Æ÷ÀÎÁö ¸ð¾çÀÎÁö ±¸ºÐÀÌ ¾î·Æ½À´Ï´Ù.

[2018-5-4. È«¼º³ë ±³¼ö´Ô ´äº¯]

À§Ä¡·Î ±¸ºÐµÉ °Í °°½À´Ï´Ù. ¸ðµÎ ¼¶À¯¼º ¹ÝÈç Á¶Á÷À¸·Î squamous epithelium¿¡ µ¤¿© ÀÖ´Â fibrotic tissue¶ó¼­ Á¶Á÷ÇÐÀûÀ¸·Î ±¸ºÐÀ» ¾î·Á¿ï °Í °°½À´Ï´Ù. ÀüÅëÀûÀ¸·Î ¾Æ·¡ ±×¸²Ã³·³ anal fissureÀÇ ¸¸¼ºÈ­ º¯È­¿¡ µ¿¹ÝµÇ´Â °ÍÀ¸·Î ¾Ë°í ÀÖ½À´Ï´Ù.

RectumÂÊ¿¡ ¹ß»ýÇÏ´Â °Í(anal canalÀÇ oral side)Àº hypertrophied papillae, perianal skinÂÊ(anal canalÀÇ anal side)¿¡ ¹ß»ýÇÏ´Â °ÍÀº skin tag·Î ºÎ¸£´Â °ÍÀÌ º¸ÅëÀÔ´Ï´Ù. ¼ö¼ú·Î anatomy¿¡ º¯ÇüÀÌ ÀÖ´Â °æ¿ì¿Í Gr2 ÀÌ»óÀÇ protruding internal hemorrhoid°¡ µ¿¹ÝµÈ °æ¿ì µî¿¡¼­´Â ±¸ºÐÀÌ ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù.


[2021-7-14. ¾Öµ¶ÀÚ Áú¹®]

º´º¯ÀÇ ÀϺΰ¡ Ç×¹®ÀÇ transitional zone¿¡ °ÉÃÄ À־ ¿ëÁ¾ Á¦°Å¸¦ ÇÏÁö ¸øÇÏ°í ±× ºÎºÐÀ» ÇÇÇØ Á¶Á÷ °Ë»ç¸¸ Çß¾ú½À´Ï´Ù.

Á¶Á÷ °Ë»ç¿¡¼­ serrated adenoma with focal HGD °¡ ³ª¿Ô´ø º´º¯Àε¥, À§Ä¡¿Í Å©±â°¡ ºÎ´ãÀÌ µÇ¾î »ó±Þ º´¿ø¿¡ ÀÇ·Ú µå¸± ¿¹Á¤ÀÔ´Ï´Ù. Dentate lineÀ̳ª transitional zone ¿¡ À§Ä¡ÇÑ º´º¯À» ¶¼¾î ³»¾úÀ» ¶§ ÅëÁõÀ̳ª ÃâÇ÷ÀÇ ¹®Á¦´Â ¹ß»ýÇÏÁö ¾Ê´Â Áö ±Ã±ÝÇÕ´Ï´Ù. ¾î´À ºÎÀ§±îÁö ÀϹÝÀûÀÎ »ý°ËÀÌ °¡´ÉÇÑ Áö ¾Ë°í ½Í½À´Ï´Ù.

[2021-7-16. ±èÅÂÁØ ±³¼ö´Ô ´äº¯]

Dentate line ±Ù¹æÀÇ ¿ëÁ¾Àº polypectomy ½ÃÇà½Ã ÅëÁõÀ» ´À³¥ ¼ö ÀÖ½À´Ï´Ù. ÀϹÝÀûÀÎ Á¶Á÷°Ë»ç´Â ´ç¿¬È÷ °¡´ÉÇϸç ÀÛÀº forcepÀ¸·Î ¿ëÁ¾ Ç¥¸é¿¡¼­ Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇÑ´Ù¸é ÀÌ¿¡ ´ëÇÑ ÅëÁõÀº Å©Áö ¾ÊÀ» °ÍÀ¸·Î »ý°¢µË´Ï´Ù. ´Ù¸¸ polypectomy ½Ã¿¡´Â ¿ëÁ¾ º¯¿¬ÀÇ Á¤»óÁ¡¸·±îÁö Á¦°ÅÇϱ⠶§¹®¿¡ ÅëÁõÀÌ ½ÉÇÒ ¼ö ÀÖ½À´Ï´Ù. ÅëÁõÀ» °¨¼Ò½ÃÅ°±â À§ÇØ submucosal injection Çϱâ Àü¿¡ lidocaine injectionÀ» ¸ÕÀú ½ÃÇàÇÏ¿© ÅëÁõ ¹ß»ýÀ» ¾î´ÀÁ¤µµ ¹æÁöÇÒ ¼ö ÀÖÀ¸¸ç CPP ÈÄ¿¡µµ ÁøÅëÁ¦ µîÀ¸·Î Á¶ÀýÀÌ ÇÊ¿äÇÒ ¼ö ÀÖ½À´Ï´Ù. CPP ÈÄ ÃâÇ÷ÀÇ °¡´É¼ºµµ ´õ Ŭ °ÍÀ¸·Î »ý°¢µÇ¸ç CPP ÈÄ endoscopic hemostasis for immediate bleedingÀÌ ÇÊ¿äÇÒ ¼ö ÀÖ½À´Ï´Ù.


[References]

1) ColonTODAY - ´ëÀå Áúȯ Áõ·Ê ÅäÀÇ

2) ¾Öµ¶ÀÚ Áõ·Ê ÆíÁö 19 - ´Ù¾çÇÑ Ç×¹® Á÷Àå Áúȯ (´ëÇ׺´¿ø Ãֿ뼺)

3) Rectal examination¿¡ ´ëÇÑ »ó¼¼ÇÑ ¼³¸í



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