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[Gastric cancer 544 - ESD Àü ¹Ýµå½Ã clopidogrelÀ» ²÷¾î¾ß Çϴ°¡?]

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60´ë ³²¼ºÀÌ ³»½Ã°æ Ä¡·á¸¦ À§ÇÏ¿© ÀǷڵǼ̽À´Ï´Ù. ¿ÜºÎ Á¶Á÷°Ë»ç °á°ú´Â low grade dysplasia with focal HGD¿´À¸¸ç, Á¶Á÷°Ë»ç ½½¶óÀ̵å ÀçÆǵ¶ °á°ú´Â high grade dysplasia ¿´½À´Ï´Ù. À§¾ÏÀÇ °¡´É¼ºÀÌ 1/3 Á¤µµ¶ó°í ¼³¸íÇÏ¿´½À´Ï´Ù.

¿Ü·¡¿¡¼­´Â ºÐ¸íÈ÷ °íÇ÷¾ÐÀ¸·Î ¾àÀ» º¹¿ë ÁßÀÌ°í, ¾Æ½ºÇǸ° µî Ç×Ç÷¼ÒÆÇÁ¦´Â µå½ÃÁö ¾Ê´Â´Ù°í Çϼ̽À´Ï´Ù. ±×·±µ¥ ÀÔ¿ø ÈÄ º´½Ç¿¡¼­ ´Ù½Ã È®ÀÎÇغ¸´Ï clopidogrelÀ» µå½Ã°í °è½Å´Ù´Â °ÍÀ̾ú½À´Ï´Ù. ClopidogrelÀÇ ÀûÀÀÁõÀº Çϳªµµ ¾ø¾ú½À´Ï´Ù. °úÀ× Áø·á°¡ ÀÏ»óÈ­µÈ ¿ì¸® ³ª¶ó¿¡¼­´Â Ưº°ÇÑ ÀûÀÀÁõ ¾øÀ̵µ À§ÇèÇÑ ¾àÀ» µå½Ã°í °è½Å ºÐÀÌ ÀûÁö ¾Ê½À´Ï´Ù. °ÅÁÖÁö´Â °æºÏÀ̾ú°í ¸î ÁÖ ±â´Ù·È´Ù°¡ ÀÔ¿øÇϽŠ»óÅ¿´½À´Ï´Ù. ¿©·¯ºÐÀº ¾î¶»°Ô ÇϽðڽÀ´Ï±î? ClopidogrelÀ» ²÷°í ¸çÄ¥ ÈÄ ´Ù½Ã ÀÔ¿øÇÏ¿© ½Ã¼úÀ» ¹Þµµ·Ï ±ÇÇϽðڽÀ´Ï±î, ¾Æ´Ï¸é ±×³É ESD¸¦ ½ÃÇàÇϽðڽÀ´Ï±î?

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Àú´Â ´çÀÏ ¾Æħ clopidogrelÀ» µå½ÃÁö ¾ÊÀº »óÅ¿¡¼­ ±×³É ESD¸¦ ÇÏ¿´°í ½Ã¼ú 5ÀÏ ÈÄ clopidogrelÀ» ´Ù½Ã º¹¿ëÄÉ ÇÏ¿´½À´Ï´Ù. ÃÖÁ¾ º´¸®°á°ú´Â ¾ÏÀ̾ú½À´Ï´Ù. ESD¸¦ ´ÊÃßÁö ¾Ê°í ½ÃÇàÇß´ø °ÍÀÌ ´ÙÇàÀ̶ó°í »ý°¢Çß½À´Ï´Ù.


Early gastric carcinoma
1. Location : antrum
2. Gross type : EGC type IIa
3. Histologic type : tubular adenocarcinoma, well differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 20 mm (2) vertical diameter, 9 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 6 mm, proximal 6 mm, anterior 4 mm, posterior 10 mm, deep 1200 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent

Ç×Ç÷¼ÒÆÇÁ¦ º¹¿ëÀÚ¿¡¼­ ESD¸¦ ÇÒ ¼ö Àִ°¡¿¡ ´ëÇÑ ³í¶õÀº °è¼ÓµÇ°í ÀÖ½À´Ï´Ù. ¾Æ½ºÇǸ°ÀÇ °æ¿ì ½Ã¼ú Àü³¯±îÁö µå¼Åµµ ºñ±³Àû ¾ÈÀüÇÏ°Ô ½Ã¼úÇÒ ¼ö ÀÖ´Ù´Â ÀϺΠ¿¬±¸µµ ÀÖ½À´Ï´Ù¸¸, clopidogrelÀÇ °æ¿ì´Â Á¦½ÃÇÒ ÀÚ·á°¡ ¾ø´Â ½ÇÁ¤ÀÔ´Ï´Ù.

Àú´Â ¾Æ½ºÇǸ°À» µå½Ã´Â ºÐÀÇ °æ¿ì Áß¿äÇÑ cardiovascular risk factor°¡ ¾øÀ¸¸é ½Ã¼ú 4ÀÏ ÀüºÎÅÍ ²÷µµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù. Cardiovascular risk factor°¡ ÀÖÀ¸¸é ¾Æ½ºÇǸ°À» ½Ã¼ú ´çÀÏ°ú ±× ´ÙÀ½ ³¯ Á¤µµ¸¸ ²÷½À´Ï´Ù. (°ü»óµ¿¸Æ stent µîÀ¸·Î) ¾Æ½ºÇǸ°°ú clopidogrelÀ» ÇÔ²² º¹¿ëÇÏ°í ÀÖ´Â °æ¿ì´Â clopidogrel¸¸ 4-5ÀÏ ²÷½À´Ï´Ù. Clopidogrel ´Üµ¶ »ç¿ëÀÚ´Â °í¹ÎÀä, ´ë°­ ¾Æ½ºÇǸ°°ú µ¿ÀÏÇÏ°Ô ÇÏ°í ÀÖ½À´Ï´Ù.

4ÀÏ Á¤µµ ²÷¾úÀ¸¸é ÁÁ¾ÒÀ» °Í °°Àº »óȲ¿¡¼­ ȯÀÚ°¡ ¾àÀ» ²÷Áö ¸øÇÏ°í ¿À½Ã¸é, ȯÀÚÀÇ risk factor¿Í ½Ã¼ú ÀÚüÀÇ risk factor¸¦ ¸ðµÎ °í·ÁÇÕ´Ï´Ù. º´¼Ò°¡ ºñ±³Àû ÀÛ°í, À§Ä¡µµ ¹«³­ÇÏ°í, ȯÀÚÀÇ °Ç°­»óŶó ÁÁÀ¸¸é clopidogrel µå¼Ì´ø ºÐµµ ½Ã¼úÇÏ°í ÀÖ½À´Ï´Ù. ±×·¯³ª º´¼Ò°¡ Å©°í, º´¼Ò À§Ä¡°¡ Á¢±ÙÀÌ ¾î·Á¿î °÷ÀÌ°í, ȯÀÚÀÇ °Ç°­»óÅ°¡ ³ª»Ú´Ù¸é ´Ù¼Ò Á¶½É½º·´°Ô Á¢±ÙÇÕ´Ï´Ù. ÀÌ È¯ÀÚÀÇ °æ¿ì´Â (1) °íµµ¼±Á¾À̹ǷΠ¾ÏÀ¸·Î Áø´ÜÀÌ ¹Ù²ð ¼ö À־ ¼­µÑ·¯ Ä¡·á°¡ ÇÊ¿äÇß°í, (2) ÀüÁ¤ºÎ ¼Ò¸¸ÀÇ À¶±âºÎ º´¼ÒÀ̹ǷΠ±â¼úÀû ³­À̵µ°¡ ³ôÁö ¾Ê¾Ò°í, (3) ¸¸¾à ÃâÇ÷ÇÏ´õ¶óµµ ³»½Ã°æÄ¡·á°¡ ¼ö¿ùÇÑ °÷À̾úÀ¸¹Ç·Î ESD Àü³¯±îÁö clopidogrelÀ» º¹¿ëÇÏ¿´Áö¸¸ ESD´Â °­ÇàÇÏ¿´½À´Ï´Ù. ¸¸¾à º´¼Ò°¡ Å©°í ¾î·Á¿î À§Ä¡¿´´Ù¸é ÀϹÝÀûÀÎ °æ¿ìó·³ 4ÀÏ Á¤µµ ²÷°í ESD¸¦ Çß¾úÀ» °Í °°½À´Ï´Ù. ¿©ÇÏÆ° ÃâÇ÷Àº ¾ø¾ú°í, ÃÖÁ¾ º´¸®°á°úµµ Á¡¸·¾Ï ¿ÏÀüÀýÁ¦·Î Àß ³ª¿Ô½À´Ï´Ù.

À§³»½Ã°æ Á¶Á÷°Ë»ç¸¦ À§Çؼ­´Â ¾Æ½ºÇǸ°°ú clopidogrel µîÀº ²÷Áö ¾Ê°í ÀÖ½À´Ï´Ù.

* Âü°í: EndoTODAY ´ëÀå³»½Ã°æ/¿ëÁ¾ÀýÁ¦¼ú Àü ¾Æ½ºÇǸ°/Ç×Ç÷¼ÒÆÇÁ¦¸¦ ²÷À» °ÍÀΰ¡?

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (2017-11-7)