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[´ëÀå °Ô½Ç, ±Þ¼º °Ô½Ç¿°, °Ô½Ç ÃâÇ÷. Colonic diverticulum, diverticulitis, diverticular bleeding] - ðû

1. ´ëÀå °Ô½Ç - ´ëÀå³»½Ã°æ »ðÀÔ °úÁ¤¿¡¼­ °Ô½ÇÀ» ÁÖÀÇÇսôÙ.

2. ±Þ¼º °Ô½Ç¿°ÀÇ ÀÓ»ó»ó - °Ô½Ç¿° ȯÀÚ ¼³¸í¼­

3. ±Þ¼º °Ô½Ç¿°ÀÇ CT, ³»½Ã°æ, ´ëÀåÁ¶¿µ¼ú ¼Ò°ß

4. ±Þ¼º °Ô½Ç¿°ÀÇ Ä¡·á - °Ô½Ç¿° Àç¹ßÀÌ¸é ²À ¼ö¼úÀ» ÇؾßÇÒ±î?, ÀþÀº °Ô½Ç¿° ȯÀÚ¿¡¼­ ¼ö¼úÀÌ ÇÊ¿äÇÑ°¡?

5. ±Þ¼º °Ô½Ç¿°ÀÇ °¨º°Áø´Ü - ´ëÀå¾Ï°ú º¹¸·¼ö¿° (appendagitis)

6. ±Þ¼º °Ô½Ç¿° ¼ö¼úÀû Ä¡·á

7. 2015³â ¹Ì±¹ ¼ÒÈ­±âÇÐȸ °¡À̵å¶óÀÎ - ±Þ¼º °Ô½Ç¿°¿¡¼­ Ç×»ýÁ¦¸¦ ²À ½á¾ß Çϴ°¡? ´ëÀå³»½Ã°æÀº ²À ÇØ¾ß Çϴ°¡?

8. SUDD¿Í SCAD (symptomatic uncomplicated diverticular disease and segmental colitis associated with diverticula)

9. ´ëÀå °Ô½Ç ÃâÇ÷

10. FAQ

11. References

2020-4-25. ¼øõ¸¸³»½Ã°æ¼¼¹Ì³ª µ¿¿µ»ó °­ÀÇ


1. ´ëÀå °Ô½Ç. Colonic diverticulum

À§Àå°ü °Ô½ÇÀº À§Àå°üº® ÀüÃþÀÌ »ßÁ®³ª¿À´Â true diverticulum°ú Á¡¸·Ãþ¸¸ »ßÁ®³ª¿À´Â pseudodiverticulumÀ¸·Î ³ª´¹´Ï´Ù. º¸ÅëÀº pseudodiverticulumÀÔ´Ï´Ù.

Sigmoid diverticulosis

Cecal diverticulosis

PseudodiverticulumÀº vasa recti°¡ °íÀ¯±ÙÃþÀ» ¶Õ°í µé¾î°¡´Â ºÎÀ§¿¡¼­ ¹ß»ýÇÕ´Ï´Ù. Áï mesenteric taeniaÀÇ ¾çÂÊ¿¡¼­ ¹ß»ýÇÕ´Ï´Ù. ¾Æ·¡ ±×¸²¿¡¼­ ¾Ë ¼ö ÀÖµíÀÌ diverticulum Á¡¸· ¹Ù·Î ¾Æ·¡¿¡ vasa recti¶ó´Â Ç÷°üÀÌ À§Ä¡ÇϹǷΠ°£È¤ ÃâÇ÷ÀÌ ¹ß»ýÇÒ ¼ö ÀÖ´Â °ÍÀÔ´Ï´Ù.

Diverticula develop on either side of the mesenteric taenia and on the mesenteric side of the antimesenteric taenia, the taenia omentalis (TO), and taenia libera (TL). These are the sites (arrows) where the vasa recta perforate the muscularis propria and penetrate the submucosa (inset).

´ëÀå³»½Ã°æ »ðÀÔ µµÁß °Ô½Ç(ƯÈ÷ S-colon diverticulum)°ú ´ëÀå lumenÀ» ±¸ºÐÇÏÁö ¸øÇÏ°í °­ÇÏ°Ô ¹Ð¾î³ÖÀ¸¸é õ°øÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù.

S-colon¿¡ ¸¹Àº °Ô½ÇÀÌ ÀÖ´ø Áõ·ÊÀÔ´Ï´Ù. S-colon ¿µ¿ª¿¡ ±¸½½°ú °°Àº ´ëº¯ÀÌ ÀÖ¾ú´Âµ¥ ÀϺδ lumen¿¡¼­ ±¸¸£°í ÀÖ¾ú°í ÀϺδ S-colon¿¡ ¹ÚÇô ÀÖ¾ú½À´Ï´Ù. Diverticular opening°ú ´ëº¯¶§¹®¿¡ ´ëÀå lumenÀ» ±¸ºÐÇϱⰡ ½±Áö ¾Ê¾Ò½À´Ï´Ù. Á¶½ÉÁ¶½É lumenÀ» ã°í blindÇÏ°Ô ¹ÐÁö ¾Ê´Â ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.

ÀÛÀº ¹èº¯ µ¢¾î¸®°¡ °Ô½Ç ¹Û(B)¿¡µµ ÀÖ°í °Ô½Ç ¾È(C)¿¡µµ º¸ÀÔ´Ï´Ù.


2. ±Þ¼º °Ô½Ç¿°ÀÇ ÀÓ»ó»ó

°Ô½ÇÀÇ ÀÓ»ó¾ç»óÀº ´Ù¾çÇÕ´Ï´Ù. Harrison 17ÆÇ(2008³â)¿¡´Â ¾Æ·¡¿Í °°Àº Ç¥°¡ ÀÖ½À´Ï´Ù. Uncomplicated°¡ ¸¹°í complicated´Â ¼Ò¼öÀÔ´Ï´Ù.

Presentation of diverticular disease
Uncomplicated diverticular disease - 75%
- abdominal pain
- fever
- leukocytosis
- anorexia/obstipation
Complicated diverticular disease - 25%
- abscess 16%
- perforation 10%
- stricture 5%
- fistula 2%

Perforated diverticular disease´Â Hinchey classificationÀ¸·Î ºÐ·ùÇÕ´Ï´Ù. Fistula°¡ ¹ß»ýÇϱ⵵ ÇÕ´Ï´Ù. ¹æ±¤°ú ¿¬°áµÇ¸é pneumaturia°¡ ¹ß»ýÇÒ ¼öµµ Àִٴµ¥... Àú´Â º» ÀûÀÌ ¾ø½À´Ï´Ù.

Hinchey classification of colonic diverticular perforation (Sleisenger 8ÆÇ)
Stage I - Confined pericolic abscess
Stage II - Distant abscess (retroperitoneal or pelvic)
Stage III - Generalized peritonitis due to rupture of a pericolic or pelvic abscess (noncommunicating with the colonic lumen because of obliteration of the diverticular neck by inflammation)
Stage IV - Fecal peritonitis due to free perforation of a diverticulum (communicating with the colonic lumen)

The Hinchey classification for acute diverticulitis (anywhere along the bowel, not just the colon) has been variously adapted and modified since its original description, and is useful not only in academia but also in outlining successive stages of severity. Adoption and utility of the various modified classifications is variable, and some aspects of diverticular disease such as fistula formation or obstruction are not addressed by most classifications.


[°Ô½Ç¿° ȯÀÚ ¼³¸í¼­]

°Ô½Ç¿°ÀÇ Áõ»óÀº Ãæ¼öµ¹±â¿°°ú ºñ½ÁÇÕ´Ï´Ù. ±×·¯³ª ´ëºÎºÐ ¼ö¼úÇÏÁö ¾Ê´Â º´À̹ǷΠȯÀڷμ­´Â ÀÌÇØÇϱ⠾î·Á¿ï ¼ö ÀÖ½À´Ï´Ù. ¸î ÁÖ ÈÄ ¹Ýµå½Ã ´ëÀå³»½Ã°æ (ȤÀº barium enema) °Ë»ç¸¦ ¹Þ¾Æ¾ß ÇÑ´Ù´Â Á¡µµ ÀǾÆÇØ ÇÒ ¼ö ÀÖ½À´Ï´Ù.

Àú´Â ȯÀÚ¿Í º¸È£ÀÚ¸¦ À§ÇÏ¿© ¼³¸íÀڷḦ ¸¸µé¾ú½À´Ï´Ù. ÇÊ¿äÇÒ ¶§¸¶´Ù ÇÑÀ徿 Ãâ·ÂÇÏ¿© »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. ÀÀ±Þ½Ç¿¡ ´©¿ö°è½Å ȯÀڵ鿡°Ô ÀÌ ÀڷḦ µå¸®¸é¼­ ¼³¸íÇÏ¸é ´ëºÎºÐ ¹«Ã´ ÁÁ¾Æµé ÇϽʴϴÙ.

¼öÁ¤ÇÏ¿© »ç¿ëÇÒ ¼ö ÀÖ´Â PPT


3. ±Þ¼º °Ô½Ç¿°ÀÇ CT, ³»½Ã°æ, ´ëÀåÁ¶¿µ¼ú ¼Ò°ß

[±Þ¼º°Ô½Ç¿° CT ¼Ò°ß]

CT¼Ò°ßÀº Sleisenger 8ÆÇ (2006)ÂÊ¿¡¼­ ¿Å±é´Ï´Ù. "CT criteria for diverticulitis include the presence of diverticula with pericolic infiltration of fatty tissue (often appearing as fat "stranding"), colonic wall thickening, and abscess formation. The earliest large series of CT findings in diverticulitis reported the finding of pericolic fat inflammation in 98%, diverticula in 84%, a colonic wall thickness greater than 4 mm in 70%, and an abscess in 35%." ¾Æ·¡ »çÁø¿¡¼­ È®ÀÎÇÒ ¼ö ÀÖ½À´Ï´Ù.

¼­¾ç °Ô½Ç¿°Àº ÁÂÃø¿¡ ¸¹Áö¸¸ ¿ì¸®³ª¶ó °Ô½Ç¿°Àº ¿ìÃø¿¡ ¸¹½À´Ï´Ù. Àú´Â ÁÂÃø °Ô½Ç¿°À» ´Ü Çѹø¹Û¿¡ °æÇèÇØ º¸Áö ¸øÇß½À´Ï´Ù (¾Æ·¡ »çÁø).

±Þ¼º°Ô½Ç¿° ȯÀÚÀÇ CT¿¡¼­ diverticulolith (¾Æ·¡ ±×¸² È­»ìÇ¥)¸¦ ¹ß°ßÇÑ °æ¿ìµµ ÀÖ¾ú½À´Ï´Ù. ÀÌ µ¹ÀÌ °Ô½Ç¿°À» ÀÏÀ¸Ä×´ÂÁö´Â ¸íÈ®ÇÏÁö ¾ÊÁö¸¸ ±×·¡µµ Èï¹Ì·Î¿î ¼Ò°ßÀÔ´Ï´Ù.


[±Þ¼º °Ô½Ç¿° ³»½Ã°æ ¼Ò°ß]

±Þ¼º °Ô½Ç¿°¿¡¼­´Â ÇÕº´ÁõÀÇ À§Ç趧¹®¿¡ °¡±ÞÀû ³»½Ã°æÀ» ÇÇÇÕ´Ï´Ù. ±×·¯³ª ¿ì¿¬È÷ ³»½Ã°æÀ» ÇÏ°Ô µÇ´Â ¼ö°¡ ÀÖ½À´Ï´Ù. ¾Æ·¡ »çÁøÀÇ ¿¹¿¡¼­´Â ¹ßÀûÀÌ ½ÉÇÏ°í pus°¡ ³ª¿À´Â ¾ç»óÀ̾ú½À´Ï´Ù.


[2013-4-22. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô. Áú¹®ÀÌ ÀÖ½À´Ï´Ù..^^ Diverticulitis·Î Ä¡·á¹Þ¾Ò°í ÀÓ»óÀû ¼Ò°ßÀ̳ª CT¼Ò°ßÀ̳ª ¸ðµÎ diverticulitis¿´´Âµ¥ 6ÁÖ ÈÄ ´ëÀå³»½Ã°æ¿¡¼­ diverticulumÀÌ ÀüÇô º¸ÀÌÁö ¾Ê¾Ò½À´Ï´Ù. ¾î¶»°Ô µÈ ÀÏÀÎÁö.. ȯÀÚ¿¡°Ô´Â ¾î¶»°Ô ¼³¸íÇØ¾ß ÇÒÁö ±Ã±ÝÇÕ´Ï´Ù. CT¼Ò°ßÀÌ false positive ¿´´ø°ÇÁö ¾Æ´Ï¸é colono¿¡¼­ miss µÈ°ÇÁö.. ¾Æ´Ï¸é Á¤¸» ÀÖ´Ù°¡ ¾ø¾îÁú ¼ö ÀÖ´ÂÁö¿ä.

[2013-4-22. ÀÌÁØÇà ´äº¯]

ÁÁÀº Áú¹®ÀÔ´Ï´Ù. Colonoscopy´Â diverticulum ÀÚü¸¦ ¹ß°ßÇϴµ¥ ½â ÁÁÀº °Ë»ç´Â ¾Æ´Õ´Ï´Ù. ±×·¯³ª diverticulitis¿Í °¨º°ÀÌ ÇÊ¿äÇÑ Áúº´À» ¹ß°ßÇϴµ¥´Â ¹«Ã´ À¯¿ëÇÕ´Ï´Ù. ¸¸¾à ÀÓ»óÀû diverticulitis ÈÄ ´ëÀå³»½Ã°æ¿¡¼­ diverticulumÀÌ ¾ø´Ù¸é ´ÙÀ½ ¼¼ °¡Áö °æ¿ì Áß ÇϳªÀÏ °ÍÀÔ´Ï´Ù.

(1) ´ëÀå³»½Ã°æ¿¡¼­ ÀÖ´Â diverticulumÀ» ¹ß°ßÇÏÁö ¸øÇÑ °æ¿ìÀÔ´Ï´Ù. °Ë»çÀÇ ÇÑ°è ¶§¹®¿¡ ¾î¿ ¼ö ¾ø´Â ÀÏÀÌ°í ÀÌ´Â ¾î´À Á¤µµ ¿¹»óµÇ´Â ÀÏÀÔ´Ï´Ù.

(2) DiverticulumÀÌ µü Çϳª ÀÖ¾ú°í ÀÌ°ÍÀÌ Ãµ°øµÇ¸é¼­ diverticulitis°¡ ¿Ô°í Ä¡·á°úÁ¤¿¡¼­ healing µÇ¾ú´Ù. ¹°·Ð ÃßÁ¤ÀÔ´Ï´Ù. Áõ°Å´Â ¾ø½À´Ï´Ù.

(3) DiverticulitisÀÌ ¾Æ´Ï¾úÀ» ¼ö ÀÖ½À´Ï´Ù. ¿¹¸¦ µé¾î epiploic appendagitis, infectious colitis ȤÀº mesenteric lymphadenitis¿Í °¨º°ÀÌ ¾î·Á¿ü´ø °æ¿ìÀÔ´Ï´Ù.

ÀÌ Áß¿¡¼­ epiploic appendagitis¿¡ ´ëÇؼ­´Â Àͼ÷ÇÏÁö ¾ÊÀº ºÐÀÌ ¸¹À» °Í °°½À´Ï´Ù. ¿©±â¸¦ ´­·¯ °øºÎÇϽñ⠹ٶø´Ï´Ù.


[±Þ¼º °Ô½Ç¿° ÈÄ ´ëÀåÁ¶¿µ¼ú ¼Ò°ß]

°Ô½Ç¿° ±Þ¼º±â°¡ Áö³ª¸é Áø´ÜÀ» È®ÀÎÇÏ°í ´Ù¸¥ ÁúȯÀ» ¹èÁ¦Çϱâ À§ÇÏ¿© ´ëÀå³»½Ã°æÀ̳ª barium enema¸¦ ÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. 2008³â Harrison ±³°ú¼­¿¡¼­´Â ´ÙÀ½°ú °°ÀÌ ¾º¿© ÀÖ½À´Ï´Ù.

"A barium enema or colonoscopy should be performed ~6 weeks after an attack of diverticular disease."

ÇÊÀÚ´Â º¸Åë 2´Þ ¹«·Æ ´ëÀå³»½Ã°æÀ» ÇÕ´Ï´Ù. °ú°Å¿¡´Â barium enema¸¦ ÇÏ¿´Áö¸¸ º°·Î ÀÕÁ¡ÀÌ ¾ø´Ù°í »ý°¢ÇÏ¿© ´ëÀå³»½Ã°æÀ¸·Î ¹Ù²Ù¾ú½À´Ï´Ù.


4. ±Þ¼º °Ô½Ç¿° Ç×»ýÁ¦ Ä¡·á¿Í Àç¹ß

ÇÕº´ÁõÀÌ ¾ø´Â °Ô½Ç¿°Àº Ç×»ýÁ¦ ¹ÝÀÀÀÌ ÁÁ½À´Ï´Ù. 2-3ÀÏ »çÀÌ¿¡ Áõ»óÀÌ ÇöÀúÈ÷ È£ÀüµÇ¸é ½ÄÀ̸¦ ½ÃÀÛÇصµ ÁÁ½À´Ï´Ù.

°£È¤ ¸çÄ¥ ±â´Ù·ÈÀ¸³ª Áõ¼¼°¡ È£ÀüµÇÁö ¾Ê´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. Ç×»ýÁ¦¸¦ ¹Ù²Ù¸é ÁÁ¾ÆÁö±âµµ ÇÕ´Ï´Ù. ÀÌ·± Àü·«À¸·Î ¼º°øÇÑ ¿¹ÀÔ´Ï´Ù.

Ç×»ýÁ¦¸¦ º¯°æÇÑ ÈÄ È£ÀüµÈ °Ô½Ç¿°

Sleisenger 8ÆÇ¿¡´Â ÀÌ·¸°Ô ¾º¿© ÀÖ½À´Ï´Ù. Antibiotic treatment should be continued for 7 to 10 days. Á¦ ȯÀÚµéÀº º¸Åë 4-5ÀÏ ÀÔ¿øÇÕ´Ï´Ù. Åð¿ø½Ã 1ÁÖ ºÐ·®ÀÇ Ç×»ýÁ¦¸¦ ó¹æÇÕ´Ï´Ù. µû¶ó¼­ µµÇÕ 10-12ÀÏ Á¤µµ Ç×»ýÁ¦¸¦ ¾²´Â ¼ÀÀÔ´Ï´Ù. ¾à°£ ¸¹´Ù°í ÇÒ ¼ö ÀÖ´Â ¼öÁØÀÔ´Ï´Ù.

°£È¤ ¾àÀ» ²÷Àº ÈÄ ¼ö ÀÏ È¤Àº ¼ö ÁÖ ³»·Î Àç¹ßÇÏ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ÀÌ °æ¿ì óÀ½ »ç¿ëÇÏ¿´´ø Ç×»ýÁ¦¸¦ º¸´Ù ¿À·£ ±â°£ »ç¿ëÇϸé ÁÁ¾ÆÁö±âµµ ÇÕ´Ï´Ù. ÀÌ·± Àü·«À¸·Î ¼º°øÇÑ ¿¹ÀÔ´Ï´Ù.

Åð¿ø ÈÄ ¾àÀ» ²÷°í ¼öÀÏ ÈÄ Áõ»óÀç¹ß·Î ÀÔ¿øÇÑ °Ô½Ç¿°


[°Ô½Ç¿° Àç¹ßÀÌ¸é ²À ¼ö¼úÀ» ÇؾßÇÒ±î?]

¼­¾ç¿¡¼­ ³»°úÀûÀ¸·Î Ä¡·áÇÑ °Ô½Ç¿°ÀÇ Àç¹ß·üÀº 7-45%À̸ç, ÀÌ Áß Àý¹ÝÀº 1³â À̳»¿¡ ¹ß»ýÇÕ´Ï´Ù (8ÆÇ Sleisenger). ù¹ø° °Ô½Ç¿°º¸´Ù Àç¹ßÀÇ °æ¿ì ³»°úÄ¡·á¿¡ ¹ÝÀÀÇÒ È®·üÀÌ ³·°í »ç¸Á·üÀÌ ³ô½À´Ï´Ù.

°Ô½Ç¿° Àç¹ßÀº ¹Ýµå½Ã ¼ö¼úÇØ¾ß ÇÑ´Ù´Â ÁÖÀåµµ ÀÖ½À´Ï´Ù. ±×·¯³ª ¸î ¹ø° Àç¹ß¿¡¼­ ¼ö¼úÀ» ÇØ¾ß ÇÏ´ÂÁö ³í¶õÀÔ´Ï´Ù. 8ÆÇ Sleisenger (2006)¿¡¼­´Â ´ÙÀ½°ú °°ÀÌ ¾º¿© ÀÖ½À´Ï´Ù.

"Elective resection generally is recommended after two attacks of uncomplicated diverticulitis, although this recommendation is now being challenged, many experts preferring to wait for two or more attacks before advising surgery."

¼­¾ç°ú µ¿¾çÀÇ Àç¹ß·ü Â÷ÀÌ¿¡ ´ëÇÑ ¾ö¹ÐÇÑ ºñ±³¿¬±¸´Â ¾ø½À´Ï´Ù. ±×·¯³ª ¿ì¸®³ª¶ó °Ô½Ç¿° ȯÀÚÀÇ Àç¹ß·üÀº ¼­¾çº¸´Ù ÈξÀ ³·½À´Ï´Ù. ÁßÁõµµµµ ´úÇÕ´Ï´Ù. µ¿¾ç¿¡¼± ¿ìÃø °Ô½Ç¿°ÀÌ ¸¹½À´Ï´Ù. ¿ìÃø °Ô½Ç¿°Àº ÁÂÃø °Ô½Ç¿°¿¡ ºñÇÏ¿© óÀ½À̳ª Àç¹ß ¸ðµÎ¿¡¼­ ³»°úÄ¡·á¿¡ Àß ¹ÝÀÀÇÕ´Ï´Ù (Komuta. 2004). µû¶ó¼­ °Ô½Ç¿°ÀÌ µÎ ¹ø ¹ß»ýÇÏ¿´´Ù´Â ÀÌÀ¯¸¸À¸·Î ¿ì¸® ȯÀÚµéÀ» ¼ö¼úÀåÀ¸·Î º¸³¾ ÀÌÀ¯´Â ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù.

Àú´Â ¾ÆÁ÷±îÁö µÎ ¹ø Àç¹ßÇÏ¿´´Ù´Â ÀÌÀ¯·Î ȯÀÚ¸¦ ¿Ü°ú·Î º¸³½ ±â¾ïÀÌ ¾ø½À´Ï´Ù.

µÎ¹ø° °Ô½Ç¿°À¸·Î IV Ç×»ýÁ¦·Î Ä¡·á

°Ô½Ç¿°ÀÇ º´·ÂÀÌ ¿©·¯¹ø ÀÖ¾ú´ø ÁöÀβ²¼­ ÇϺ¹ºÎ°¡ °ú°Å¿Í µ¿ÀÏÇÏ°Ô ¾ÆÇÁ´Ù°í ½º½º·Î °Ô½Ç¿° Àç¹ßÀ» Áø´ÜÇÏ¿© ¾î¶»°Ô Çϸé ÁÁ°Ú´ÂÁö ¹®ÀÇ ÀüÈ­¸¦ ¹ÞÀº ÀûÀÌ ÀÖ½À´Ï´Ù. ¸çÄ¥ µ¿¾È soft diet¸¦ ÇÏ°í °æ±¸ Ç×»ýÁ¦¸¦ ¸Ôµµ·Ï ÇÏ¿´´Âµ¥ È£ÀüµÇ¾ú´Ù°í °¨»çÇÏ´Ù´Â ÀüÈ­°¡ ¿Ô½À´Ï´Ù. °æÇÑ °Ô½Ç¿° Àç¹ßÀº °æ±¸ Ç×»ýÁ¦·Î Ä¡·áÇÒ ¼ö ÀÖ½À´Ï´Ù.

µå¹°°Ô ÀþÀº ȯÀÚ°¡ ³Ê¹« ÀæÀº Àç¹ß·Î ¼ö¼úÀ» ±ÇÀ¯¹Þ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. Cecum ±ÙóÀÇ °Ô½Ç¿° ¹Ýº¹ Àç¹ß·Î ÀÇ·ÚµÈ È¯ÀÚÀÔ´Ï´Ù. °Ô½ÇÀÌ ´Ù¹ß¼ºÀ̹ǷΠ¼ö¼ú ¹üÀ§¸¦ Á¤Çϱ⠾î·Æ±â ¶§¹®¿¡ ´ëÀå³»½Ã°æÀ» Çϸ鼭 °¡Àå distal¿¡ À§Ä¡ÇÑ °Ô½Çº¸´Ù ¾à°£ distal¿¡ markingÀ» ÇÏ¿´½À´Ï´Ù.

¼ö¼ú ¹üÀ§ °áÁ¤À» À§ÇÏ¿© markingÀ» ½ÃÇà


[ÀþÀº °Ô½Ç¿° ȯÀÚ¿¡¼­ ¼ö¼úÀÌ ÇÊ¿äÇÑ°¡?]

ÀþÀº ȯÀÚÀÇ °Ô½Ç¿°Àº °ð¹Ù·Î ¼ö¼úÇÑ´Ù°í ¹è¿ü½À´Ï´Ù. Ã¥¿¡ ±×·¸°Ô ¾º¿´±â ¶§¹®ÀÔ´Ï´Ù. ±×·¯³ª ¾Æ¹«µµ ±×·¸°Ô ÇÏÁö ¾Ê½À´Ï´Ù. ¿ÖÀϱî¿ä?

ÀÌÀ¯´Â µÎ °¡Áö¶ó°í »ý°¢ÇÕ´Ï´Ù. (1) ¿ì¸®³ª¶ó¿¡´Â ¿ìÃø°Ô½Ç¿°ÀÌ ¸¹Àºµ¥ ÀÌ °æ¿ì Àç¹ß·üÀÌ ³·½À´Ï´Ù (2) ´ÜÁö ÀþÀº ȯÀÚÀÇ ÁÂÃø°Ô½Ç¿°À̶ó°í °ð¹Ù·Î ¼ö¼úÀ» ±ÇÇØ¾ß ÇÏ´ÂÁö ³í¶õÀÌ ÀÖ½À´Ï´Ù.

16ÆÇ Harrison (2004³â)±îÁö´Â ÀÌ·¸°Ô ¾º¿© ÀÖ¾ú½À´Ï´Ù. "Patients under age 40 should undergo surgical excision following the first episode of documented diverticultitis." Áï ù attackÀÌ¶óµµ ¼ö¼úÇ϶ó´Â °ÍÀ̾ú½À´Ï´Ù.

17ÆÇ Harrison (2008³â)ºÎÅÍ´Â ³íÁ¶°¡ ¹Ù²î¾ú½À´Ï´Ù. "Younger patients may experience a more aggressive form of the disease; therefore, waiting beyond two attacks is no recommended." Áï µÎ¹ø° attack¿¡¼­ ¼ö¼úÇ϶ó´Â °ÍÀ¸·Î ¹Ù²î¾ú½À´Ï´Ù.

8ÆÇ Sleisenger (2006³â)¿¡´Â ÀÌ·¸°Ô ¾º¿© ÀÖ½À´Ï´Ù. "When patients with acute diverticulitis are managed nonoperatively, youth is an independent risk factor for poor outcome in subsequent course, possibly due to delay in diagnosis. For these reasons, some authors advocate elective segmental colectomy in a healthy young person after one well-documented episode of diverticulitis, others have questioned this approach." Áï ³í¶õÀÌ ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù.

Á¦°¡ º¸±â¿¡´Â complicated diverticulitis°¡ µÇ±â Àü±îÁö´Â ¸î ¹øÀÇ attackÀÌ ÀÖ´õ¶óµµ ÀÏ´Ü Ç×»ýÁ¦·Î Ä¡·áÇÏ´Â °ÍÀÌ ÁÁÀ» °Í °°½À´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­ °Ô½Ç¿° Àç¹ß·Î ¼ö¼úÇÑ ¿¹´Â ¸Å¿ì µå¹°±â ¶§¹®ÀÔ´Ï´Ù.

Ç×»ýÁ¦·Î Ä¡·áÇÑ °Ô½Ç¿° Àç¹ß


5. °¨º°Áø´Ü

[´ëÀå¾Ï]

RUQ pain,fever·Î Ÿº´¿ø ÀÀ±Þ½ÇÀ» ÅëÇÏ¿© ÀÔ¿øÇÏ¿´°í ´ç½Ã °Ë»ç¼Ò°ßÀº ´ÙÀ½°ú °°¾Ò½À´Ï´Ù. CBC : WBC 16500, CRP : 111 CEA : 5.8, AP CT : r/o diverticulitis. ±Ý½Ä°ú Ç×»ýÁ¦ Åõ¿© µîÀ¸·Î Ä¡·áÇÏ¿´À¸³ª Áõ»óÀÇ È£ÀüÀÌ ¾ø¾î Àü¿øµÇ¾úÀ¸¸ç ÃÖÁ¾ÀûÀ¸·Î right side colonÀÇ adenocarcinoma·Î Áø´ÜµÇ¾ú½À´Ï´Ù.

°Ô½Ç¿° ȯÀÚ¿¡¼­ ¿°ÁõÀÌ ½ÉÇÒ ¶§¿¡´Â ´ëÀå³»½Ã°æ °Ë»ç°¡ À§ÇèÇÏ´Ù´Â ÀνÄÀÌ ÆعèÇØ ÀÖÁö¸¸, ´Ù¸¥ °¨¿°¼º Áúȯ¿¡¼­ÀÇ ´ëÀå³»½Ã°æ °æÇèÀ¸·Î ¹Ì·ç¾îº¼ ¶§ ½Ç»ó ±× À§Ç輺ÀÌ ´ë´ÜÈ÷ Å« °ÍÀº ¾Æ´Õ´Ï´Ù. ÀÓ»ó»ó°ú CT ¼Ò°ßÀ¸·Î ÀüÇüÀû °Ô½Ç¿°À̶ó ÆÇ´ÜµÇ¸é ´ëÀå³»½Ã°æ °Ë»ç¸¦ ¼­µÎ¸¦ ÇÊ¿ä´Â ¾ø½À´Ï´Ù. ±×·¯³ª °Ô½Ç¿° impressionÇÏ¿¡ ±Ý½ÄÀ» ÇÏ°í Ç×»ýÁ¦¸¦ Åõ¿©ÇÏ¿´À¸³ª ¶Ñ·ÇÇÑ Áõ¼¼ÀÇ È£ÀüÀÌ ¾øÀ¸¸é Áï½Ã ´ëÀå³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. ¼³È¤ Ç×»ýÁ¦ µîÀÇ ³»°úÀû Ä¡·á¿¡ ÁÁÀº ¹ÝÀÀÀ» º¸¿© Åð¿øÀ» ÇÏ¿´´õ¶ó°í ªÀº ½Ã°£ (4-8ÁÖ) ³»¿¡ ´ëÀå ³»½Ã°æ ¶Ç´Â barium enema¸¦ ½ÃÇàÇÏ¿© ¾Ç¼ºÁúȯÀÌ ¾Æ´ÑÁö °¨º°ÇØ¾ß ÇÕ´Ï´Ù. µÑ Áß Çϳª¸¦ °í¸£¶ó¸é... ¹°·Ð ´ëÀå³»½Ã°æÀÌ ´õ ÁÁ½À´Ï´Ù.


¶Ç ´Ù¸¥ ȯÀÚÀÔ´Ï´Ù. ÇϺ¹ºÎ ÅëÁõÀ¸·Î ÀÀ±Þ½Ç ³»¿øÇÏ¿´°í ±âº» °Ë»ç ÈÄ diverticulitis with abscess formation À̶ó´Â impressionÀ¸·Î ÀÔ¿øÇϼ̽À´Ï´Ù. ÀÔ¿ø ÈÄ ´Ù½Ã Çѹø CT¸¦ Æǵ¶ÇÏ¿´°í ´ëÀå¾ÏÀÌ ÀǽɵǾî Áï½Ã ¼ö¼úÀ» ÇÏ¿´½À´Ï´Ù.


Sigmoid colon, appendix, and small intestine, Hartmann operation: Adenocarcinoma, well differentiated
1. Location: rectosigmoid junction
2. Gross type: ulcerofungating
3. Size: 7x3 cm
4. Depth of invasion: penetrates visceral peritoneum(pT4a)
5. Resection margin: free from carcinoma, safety margin: proximal, 21 cm ; distal, 14 cm ; circumferential, >10.0 mm
6. Regional lymph node metastasis : Metastasis to 2 out of 24 regional lymph nodes(pN1b)
7. Lymphatic invasion: present
8. Venous invasion: not identified
9. Perineural invasion: not identified
10. Tumor budding : negative
11. Micropapillary component: no
12. Tumor border: infiltrative
13. Pathologic staging: pT4a N1b

½Ç·ÂÀÖ´Â ¿µ»óÀÇÇаú ÀÇ»ç¿Í ÇÔ²² ÀÏÇÑ´Ù´Â °ÍÀº Å« Çà¿îÀÔ´Ï´Ù.


[Appendagitis. º¹¸·¼ö¿°]

Primary epiploic appendagitis(¿ø¹ß¼º º¹¸·¼ö¿°)Àº ´ëÀ庮¿¡ ´Þ¸® epiploic appendage(º¹¸·¼ö)ÀÇ ¿øÀÎ ¹Ì»óÀÇ ¿°ÀüÀ̳ª ÇãÇ÷¿¡ ÀÇÇÏ¿© ÅëÁõÀÌ ¹ß»ýÇÏ´Â ÁúȯÀÔ´Ï´Ù. ÀúÀý·Î ÁÁ¾ÆÁö´Â º´À̹ǷΠÇ×»ýÁ¦³ª ¼ö¼ú µî Ưº°ÇÑ Ä¡·á°¡ ÇÊ¿ä¾ø½À´Ï´Ù. ¾ÆÁÖ °£È¤ ÁøÅëÁ¦¸¸ ¾²¸é µË´Ï´Ù.

CT¿¡¼­ º¸ÀÌ´Â Á¤»ó appendage

ÀÓ»ó ¾ç»ó¸¸À¸·Î´Â ±Þ¼º Ãæ¼öµ¹±â¿°À̳ª °Ô½Ç¿°°ú ºñ½ÁÇÏ¿© °¨º°ÀÌ ¾î·Æ½À´Ï´Ù. °ú°Å¿¡´Â °£È¤ appendagitis¸¦ ±Þ¼º Ãæ¼öµ¹±â¿°À̳ª °Ô½Ç¿°À» ¿ÀÀÎÇÏ¿© ¼ö¼úÇÏ´Â °æ¿ìµµ ÀÖ¾ú½À´Ï´Ù. ±×·¯³ª ÃÖ±Ù¿¡´Â °æÇèÀÖ´Â ¿µ»óÀÇÇаú Àǻ簡 ÃÊÀ½Æijª CTÅëÇÏ¿© Áø´ÜÇÒ ¼ö ÀÖ½À´Ï´Ù. ´ëÀåÀÇ À帷°ú ¿¬°áµÇ¾î ÀÖ°í 1-2mm µÎ²²ÀÇ °íÀ½¿µ ¼±À¸·Î ½×ÀÎ µÕ±Ù Áö¹æÁ¾±«·Î °üÂûµË´Ï´Ù. º´º¯ÀÇ Á߽ɿ¡ ±ä ¼±ÇüÀÇ È¤Àº °æ°è°¡ ºÐ¸íÇÏÁö ¾ÊÀº °íÀ½¿µ ºÎÀ§°¡ µ¿¹ÝµË´Ï´Ù.

[Âü°íÀÚ·á]

¿ø¹ß¼º º¹¸·¼ö¿°ÀÇ ÀÓ»ó»ó. ÀÌÁØÇà. ´ëÇѼÒÈ­±âÇÐȸÁö 2001

2022-1-25 »ï¼º¼­¿ïº´¿ø ¾Ïº´¿ø ½Ä´ç ¾Õ °Ô½ÃÆÇ


6. ±Þ¼º °Ô½Ç¿° ¼ö¼úÀû Ä¡·á

³»°úÀÇ»çÀÎ Àú´Â °Ô½Ç¿° ¼ö¼ú¿¡ ´ëÇÏ¿© Àß ¸ð¸¨´Ï´Ù. ´Ù¸¸ ³»°úÂÊ ±³°ú¼­¿¡¼­ ÀϺθ¦ ¿Å±æ »ÓÀÔ´Ï´Ù. ´ëºÎºÐ sigmoid diverticulitis¿¡ ´ëÇÑ ³»¿ëÀ̾ú½À´Ï´Ù.

Hartmann ¼ö¼úÀÌ ¹«¾ùÀÎÁö ¾Æ½Ê´Ï±î? º´º¯À» ÀýÁ¦ÇÑ ÈÄ one stage·Î ¼ö¼úÀ» ¸¶Ä¥ ¼ö ¾ø´Â °æ¿ì, Áï immediate anastomosis¸¦ ÇÒ ¼ö ¾ø´Â °æ¿ì¿¡ rectal stump¸¦ ´Ý¾ÆÁÖ°í proximal colostomy¸¦ ¸¸µå´Â ¼ö¼úÀÔ´Ï´Ù. ¾Æ·¡ table¿¡ ¾ð±ÞµÈ °Íó·³ ½ÉÇÑ °Ô½Ç¿°ÀÇ ¼ö¼ú¿¡ ¸¹ÀÌ ¾²¿´´ø ¸ð¾çÀÔ´Ï´Ù. ÃÖ±Ù¿¡´Â Ç×»ýÁ¦¸¦ »ç¿ëÇÏ¿© ¿°ÁõÀ» Ãà¼Ò½ÃŲ ÈÄ one stage·Î ¼ö¼úÀ» ¸¶Ä¡´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. Harrison 16ÆÇ(2004³â)°ú 17ÆÇ(2005³â)¿¡ °è¼Ó ½Ç¸®°í ÀÖ´Â table Çϳª¸¦ ¼Ò°³ÇÕ´Ï´Ù.

Outcome following surgical therapy for complicated diverticular disease
- Hinchy stage I: resection with primary anastomosis without diverting stoma (morbidity 20%)
- Hinchy stage II: resection with primary anastomosis +/- diversion (morbidity 30%)
- Hinchy stage III: Hartmann's procedure vs. diverting colostomy and omental pedal graft (0 vs. 6% mortality)
- Hinchy stage IV: Hartmann's procedure vs. diverting colostomy and omental pedicle graft (6 vs. 2% mortality)

¼ö¼ú ÈÄ Àç¹ßÀÌ °¡´ÉÇÕ´Ï´Ù. Sleigenger 8ÆÇ (2006³â) 2621 ÂÊ¿¡¼­ ¿Å±é´Ï´Ù. "10% of patients will have symptomatic recurrent diverticulitis after surgical resection, and reoperation may be required in 2% to 3%. In patients undergoing resection for diverticulitis, higher recurrence rates occur when the sigmoid colon is used for the distal resection margin, rather than the rectum. Therefore, its is recommended to resect the entire distal colon whenever possible, forming the distal anastomosis with the proximal rectum and the proximal anastomosis with a noninflammed, non-diverticular-bearing portion of the colon"

À̸¦ ´Ù½Ã Ç®¾îº¸¸é... °Ô½ÇÀ» ¸ðµÎ Á¦°ÅÇÏ´Â °Í¸¸ÀÌ ´É»ç´Â ¾Æ´Õ´Ï´Ù. ¸ðµç °Ô½ÇÀ» Á¦°ÅÇÏ´Â °ÍÀº ´ç¿¬ÇÑ ÀÏÀÌ°í ¾Æ¿ï·¯ ÇâÈÄ °Ô½ÇÀÌ ¹ß»ýÇÒ ¼ö ÀÖ´Â distal colonÀ» ¾ø¾Ö¾ß¸¸ »Ñ¸®¸¦ »ÌÀ» ¼ö ÀÖ½À´Ï´Ù.


7. 2015³â ¹Ì±¹ ¼ÒÈ­±âÇÐȸ °¡À̵å¶óÀÎ (Gastroenterology 2015)

ÇÕº´ÁõÀÌ ¾ø´Â ±Þ¼º °Ô½Ç¿°(AUD; acute uncomplicated diverticulitis)Àº Áø´Ü°ú Ä¡·á°¡ ´Ü¼ø¸í·áÇÑ º´À¸·Î °£ÁÖµÇ¾î ¿Ô½À´Ï´Ù. Editorial (Antibiotics for AUD: Time for a paradigm change?)ÀÇ Ç¥ÇöÀ» ¿Å±â¸é "ù´Þ ÀÎÅϵµ ¾È´Ù(even a fresh-faced July intern knows)"°í ÇÒ Á¤µµÀÔ´Ï´Ù. CT·Î Áø´ÜÇÏ°í Ç×»ýÁ¦¸¦ ¾²¸é ±×¸¸À̾ú½À´Ï´Ù. 2013³â ´ëÇѳ»°úÇÐȸÁö Á¾¼³¿¡¼­µµ Ç×»ýÁ¦ Ä¡·á´Â ±âº»À̾ú½À´Ï´Ù.

±×·±µ¥ 2015³â ¹Ì±¹ ¼ÒÈ­±âÇÐȸ °¡À̵å¶óÀο¡¼­´Â Ç×»ýÁ¦¸¦ Ç×»ó ¾²´Â °Í(routinely)ÀÌ ¾Æ´Ï¶ó ¼±ÅÃÀûÀ¸·Î(selectively) ¾²µµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù. Áï »óȲ¿¡ µû¶ó¼­ ±Þ¼º °Ô½Ç¿° ȯÀÚ¿¡¼­ Ç×»ýÁ¦¸¦ ¾²Áö ¾ÊÀ» ¼öµµ ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù. Editorial¿¡¼­ paradigm change¸¦ ¾ð±ÞÇÑ °Íµµ °úÀåÀÌ ¾Æ´Õ´Ï´Ù. µ§¸¶Å©, ³×´ú¶õµå, ÀÌÅ»¸®¾Æ, µ¶ÀÏ µîÀº ÀÌ¹Ì Ç×»ýÁ¦¸¦ ¾²Áö ¾ÊÀ» ¼ö ÀÖ´Ù´Â °¡À̵å¶óÀÎÀ» ³Â´Ù°í ÇÕ´Ï´Ù.

Ç×»ýÁ¦ ÀÌÀü ½Ã´ëÀÇ ±Þ¼º °Ô½Ç¿°Àº ¸Å¿ì ½É°¢ÇÑ Áúº´À¸·Î »ç¸Á·üµµ ³ô¾Ò½À´Ï´Ù. Ç×»ýÁ¦¸¦ »ç¿ëÇÑ ÀÌÈÄ·Î ±Þ¼º °Ô½Ç¿°Àº Àß Ä¡·áÇÒ ¼ö ÀÖ´Â º´ÀÌ µÇ¾ú½À´Ï´Ù. ±×·±µ¥ °©ÀÚ±â Ç×»ýÁ¦¸¦ ¾²Áö ¾Ê¾Æµµ ÁÁÀº ±Þ¼º °Ô½Ç¿°ÀÌ ÀÖ´Ù´Ï È¥¶õ½º·¯¿ï ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ºÐ¸í subgroupÀÌ ÀÖÀ» °ÍÀε¥ Àß ¾Ë·ÁÁ® ÀÖÁö ¾Ê½À´Ï´Ù. EditorialÀÇ °á·Ðµµ ¾Ö¸ÅÇϱ⠱×Áö ¾ø½À´Ï´Ù. ´Ù¼Ò ºñ°ÌÇÑ °á·ÐÀ̱⵵ ÇÕ´Ï´Ù. Àǻ簡 °áÁ¤ÇØ¾ß ÇÒ ¸òÀ» ȯÀÚ¿¡°Ô ¶° ³Ñ±â°í ÀÖÀ¸´Ï±î¿ä.

One could appropriately, and in good conscience, withhold antibiotics and ensure close follow-up of their patient. Anotherprovidermight insteadrationally choose to prescribe antibiotics, arguing that the trials to date are low quality and our decades of experience treating patients with antibiotics and obtaining good outcomes are truly the best evidence to date. For those torn between these 2 alternatives, it might be best to lay out the facts as we understand them and allow the patient a role in this decision."

½ÇÁ¦·Î Ç×»ýÁ¦¸¦ ¾²Áö ¾Ê°í ÁÁ¾ÆÁö´Â °Ô½Ç¿°ÀÌ ÀÖ±â´Â ÇÕ´Ï´Ù. ´Ù¸¥ º´À¸·Î Á¤±âÀûÀ¸·Î CT¸¦ Âï´Â ºÐÀÔ´Ï´Ù. CT´Â S °áÀå °Ô½Ç¿° ¼Ò°ßÀ̾ú½À´Ï´Ù. CT °Ë»ç 1ÁÖÀÏ ÈÄÂë ¿Ü·¡¿¡ ¿À¼Ì½À´Ï´Ù. °Ô½Ç¿°À¸·Î Ç×»ýÁ¦¸¦ µå¼Ì´ø º´·ÂÀÌ ÀÖ¾ú½À´Ï´Ù. CT °Ë»ç Àü ¸çÄ¥°£ ÇϺ¹ºÎ°¡ ¾ÆÆÍ°í ¾à°£ ÁÁ¾ÆÁø »óÅ¿¡¼­ CT¸¦ Âï¾ú°í ¿Ü·¡ ¹æ¹® ½Ã´Â ´Ù ÁÁ¾ÆÁø »óȲÀ̾ú½À´Ï´Ù. Ưº°ÇÑ ¾àÀº µå½ÃÁö ¾Ê¾Ò´Ù°í ÇÕ´Ï´Ù.

F55 (2018)

Àú´Â ´çºÐ°£ Ç×»ýÁ¦¸¦ »ç¿ëÇÏ·Á°í ÇÕ´Ï´Ù. ´Ù¸¸ ÁßÁõ ȯÀÚ°¡ ¾Æ´Ï¸é °ú°Åº¸´Ù Á¶±Ý ¾àÇÏ°Ô, Á¶±Ý ª°Ô ½áº¼±î ÇÕ´Ï´Ù.


±Þ¼º °Ô½Ç¿° ȯÀÚ Ä¡·áÀÇ ¶Ç ´Ù¸¥ À̽´´Â '´ëÀå³»½Ã°æ °Ë»ç¸¦ ²À ÇØ¾ß Çϴ°¡?'ÀÔ´Ï´Ù. À۳⿡ ±è¿µÈ£ ±³¼ö´Ô²²¼­´Â ´ëÀå³»½Ã°æÀ» ÇÏÁö ¾Ê¾Æµµ ÁÁÀ» °Í °°´Ù´Â ³í¹®À» ¹ßÇ¥ÇϽŠ¹Ù ÀÖ½À´Ï´Ù (Kim MJ. Intest Res2014).

±×·¯³ª 2015³â ¹Ì±¹ °¡À̵å¶óÀÎÀº ¾ÆÁ÷µµ ´ëÀå³»½Ã°æÀ» Çϵµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù. Àú´Â Áö±Ýó·³ ´ëÀå³»½Ã°æ °Ë»ç¸¦ °è¼Ó ÃßõÇÒ±î ÇÕ´Ï´Ù. º¸Åë Åð¿ø 2´Þ ÈÄ¿¡ ÇÏ°í ÀÖ½À´Ï´Ù.

2018³â 3¿ù Gut Liver¿¡ ½Ç¸° ¸®ºä¿¡¼­µµ °Ô½Ç¿° ÀÌÈÄ ´ëÀå³»½Ã°æÀ» Çϵµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù.

¾Æ½ºÇǸ°À» ¾²Áö ¸»µµ·Ï ±ÇÇÒ ÇÊ¿ä´Â ¾øÀ¸³ª ´Ù¸¥ NSAID´Â °¡±ÞÀû ¾²Áö ¾Êµµ·Ï ±ÇÇÏ´Â °ÍÀÌ ÁÁÀ» °Í °°½À´Ï´Ù. Probiotics´Â ¾²Áö ¸»¶ó°í Çϳ׿ä. ¾Æ·¡¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù.


[2015-12-20. Àü¹®°¡ (¼­¿ï´ëº´¿ø õÀ翵) comment]

À¯·´°ú ¹Ì±¹ °¡À̵å¶óÀο¡¼­, uncomplicated AUD ȯÀÚ¿¡¼­ not routinely ¶Ç´Â selectively Ç×»ýÁ¦¸¦ Åõ¿©ÇÒ °ÍÀ» ±Ç°íÇÏ°Ô µÈ 2°³ÀÇ RCT¸¦ ¸®ºäÇغýÀ´Ï´Ù. ÇÑ ¿¬±¸´Â ³×´ú¶õµå¿¡¼­ ÁøÇàµÈ ¿¬±¸Àε¥ ÃÊ·Ï ÀÌÈÄ ³í¹®À¸·Î ¹ßÇ¥µÇÁö ¾Ê¾Ò½À´Ï´Ù.

´Ù¸¥ ÇÑ ¿¬±¸´Â ½º¿þµ§, ¾ÆÀ̽½¶õµå¿¡¼­ uncomplicated AUD ÀÔ¿øȯÀÚ 669¸í¿¡°Ô IV Ç×»ýÁ¦¿Í placebo¸¦ 1:1·Î ºñ±³ÇÏ¿© ÇÕº´Áõ ¹ß»ý ¹× Àç¿ø±â°£À» ºñ±³ÇÏ¿´´Âµ¥ ¾ç ±ºÀÇ Â÷ÀÌ°¡ ¾ø¾ú½À´Ï´Ù. ±×·¯³ª ÀÌ¹Ì ¿¬±¸ µî·Ï Àü¿¡ Ç×»ýÁ¦¸¦ Åõ¿© ÁßÀΠȯÀÚµéÀÌ Á¦¿ÜµÇ¾î »ó´ëÀûÀ¸·Î °æÁõÀÇ È¯ÀÚ¸¸ Âü¿©ÇÏ°Ô µÇ´Â selection bias°¡ ¹ß»ýÇßÀ»ÅÙµ¥ ¸î ¸íÀ̳ª Á¦¿ÜµÇ¾ú´ÂÁö ¾ð±ÞÀÌ ¾ø½À´Ï´Ù. ¶ÇÇÑ, Ç×»ýÁ¦¸¦ Åõ¿©ÇÏÁö ¾ÊÀº ±×·ìÀÇ ¾à 3%´Â ÀÓ»óÀû ¾ÇÈ­·Î Ç×»ýÁ¦ Åõ¿©°¡ ÇÊ¿äÇß´Ù°í ÇÕ´Ï´Ù. ºñ·Ï Åë°èÀûÀÎ Àǹ̴ ¾øÁö¸¸ õ°ø, ³ó¾ç µî ÇÕº´Áõ ¹ß»ý·üµµ Ç×»ýÁ¦¸¦ Åõ¿©ÇÏÁö ¾ÊÀº ±×·ìÀÌ ¾à 2¹è ³ô¾Ò½À´Ï´Ù (1.9% vs. 1%). °á±¹ AGA °¡À̵å¶óÀÎ ÁýÇÊÁøÀº µÎ RCTÀÇ ±Ù°Å ¼öÁØÀ» "low"·Î ÆÇ´ÜÇß½À´Ï´Ù.

ÀÌ¹Ì ¿ª»çÀûÀ¸·Î Ç×»ýÁ¦ µµÀÔ°ú ÇÔ²² ±Þ°ÝÇÑ AUDÀÇ ¿¹ÈÄ°¡ Çâ»óµÇ´Â '°¡Àå È®½ÇÇÑ ¿ªÇÐÀûÀÎ ±Ù°Å'¸¦ °æÇèÇÑ ÀÌ»ó, ÇöÀç·Î¼­´Â uncomplicated AUD ȯÀÚ¿¡¼­ Ç×»ýÁ¦¸¦ ó¹æÇÏÁö ¾ÊÀ» ÀÌÀ¯´Â ¾ø´Ù°í º¾´Ï´Ù. ´Ù¸¸, uncomplicated AUD´Â ¿ì·ÁÇÏ´Â °Íº¸´Ù ÈξÀ ¿¹ÈÄ°¡ ÁÁ°í Ä¡·á°¡ Àß µÇ±â ¶§¹®¿¡, Àå±â°£ Ç×»ýÁ¦ Åõ¿©¿¡ µû¸¥ ¹®Á¦°¡ ¹ß»ýÇÒ °¡´É¼º(Ç×»ýÁ¦ ³»¼º, C. difficile °¨¿° µî)¿¡ ´ëÇؼ­ °æ°¢½ÉÀ» °¡Áö°í, ºÒÇÊ¿äÇÑ Ç×»ýÁ¦ ó¹æÀ» ÃÖ¼ÒÈ­Çϵµ·Ï ³ë·ÂÇØ¾ß ÇÏ°Ú½À´Ï´Ù.


8. SUDD (symptomatic uncomplicated diverticular disease) and SCAD (segmental colitis associated with diverticula)

2013³â 4¿ù ´ëÇѼÒÈ­±âÇÐȸ PG ÄÚ½º¿¡¼­ °Ô½Ç Áúȯ¿¡ ´ëÇÑ ÃÖ±ÙÀÇ °³³äº¯È­¿¡ ´ëÇÑ °­ÀǸ¦ Èï¹Ì·Ó°Ô µé¾ú½À´Ï´Ù. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights¶ó´Â ¸®ºä¿¡¼­ ºñ½ÁÇÑ ³»¿ëÀÌ ÀÖ¾î À̸¦ ¼Ò°³ÇÕ´Ï´Ù.

DiverticulumÀ» °¡Áø ȯÀÚ´Â diverticulitis attackÀÌ ¾ø¾îµµ »îÀÇ ÁúÀÌ ¶³¾îÁý´Ï´Ù. ÀÌ·± °³³äÀÌ symptomatic uncomplicated diverticular disease (SUDD)·Î ¸í¸íµÈ °Í °°½À´Ï´Ù. °Ô½Ç¿¡ ´ëÇÑ ÀüÅëÀûÀÎ ¼³¸í, Áï ¾àÇÑ ºÎºÐÀÌ »ßÁ®³ª°¡°í µ¹°°Àº °Í¿¡ ÀÇÇØ ¸·È÷¸é °Ô½Ç¿°ÀÌ µÈ´Ù´Â ÇغÎÇÐÀû ¼³¸íÀº Á¡Â÷ ¼³µæ·ÂÀ» ÀҾ°í ÀÖ½À´Ï´Ù. ´ë½Å low grade inflammation, sensory-motor nerve damage, dysbiosis µîÀ» µ¿¹ÝÇÑ irritable bowel syndrome°ú ºñ½ÁÇÑ ÁúȯÀ¸·Î ÀÌÇصǰí ÀÖ½À´Ï´Ù.

SCAD (segmental colitis associated with diverticula)¶ó´Â ¹¦ÇÑ À̸§µµ ÀÖ½À´Ï´Ù. °Ô½Ç ÁÖº¯ÀÇ ÀϺθ¸ segmentalÇÏ°Ô IBD¿Í ºñ½ÁÇÑ ¸ð½ÀÀ» º¸ÀÌ´Â »óȲÀ» ¸»ÇÕ´Ï´Ù. ¸®ºä¿¡´Â ÀÌ·± ±â¼úµµ ÀÖ½À´Ï´Ù."Case series reveal that in a small subset of patients (~10%), SCAD evolves into frank IBD, suggesting that SCAD may be a forme fruste of IBD. SCAD in perhaps the most powerful example that inflammation and diverticulosis can go hand-in-hand, and that traditional explanations for diverticular disease involving local trauma and obstruction are probably insufficient."

Diverticulosis¿¡ ´ëÇÑ ÀÌÇØ°¡ ÀÌ·¸°Ô º¯°æµÇ¸é¼­ Ä¡·á¹æÇâµµ ¿µÇâÀ» ¹Þ´Â ¸ð¾çÀÔ´Ï´Ù. Ä¡·á ºÎºÐÀº ÀÌ·± ³»¿ëÀÌ Æ÷ÇԵǾî ÀÖ½À´Ï´Ù.
1) fiber supplementation
2) mesalamine (5-ASA)
3) rifaximin
4) probiotics


9. ´ëÀå °Ô½Ç ÃâÇ÷

°Ô½Ç ÃâÇ÷¿¡¼­ °¡Àå ¾î·Á¿î Á¡Àº ´Ù¹ß¼º °Ô½Ç Áß ¾îµð¿¡¼­ ÃâÇ÷À» ÇÏ¿´´ÂÁö ¾Ë ¼ö ¾ø´Ù´Â Á¡ÀÔ´Ï´Ù. ÀÌ ¶§¹®¿¡ ¹Ýº¹ °Ë»ç¸¦ ÇÏ´Â °æ¿ì°¡ ÈçÇÕ´Ï´Ù. °æ¿ì¿¡ µû¶ó¼­´Â °ø±â¸¦ ÁÖÀÔÇÏÁö ¾Ê°í ¹°À» ³Ö¾î¼­ °üÂûÇÒ ¼ö ÀÖ½À´Ï´Ù (ÇÑ ±³¼ö´ÔÀÇ Facebook posting capture).

´ëÀå¿¡ ´Ù¹ß¼º °Ô½ÇÀÌ ÀÖ¾úÁö¸¸ ÃâÇ÷ º´¼Ò´Â terminal ileum °Ô½ÇÀ̾ú´ø °æ¿ì. ClipÀ¸·Î ÁöÇ÷¼ú ½ÃÇà.

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from Facebook (°­»ó¹ü ±³¼ö´Ô)

[2017-6-12. ¾Öµ¶ÀÚ Áú¹®]

°Ô½Ç ÃâÇ÷¿¡¼­ ´ëÇÑ Áú¹®ÀÔ´Ï´Ù. (1) ´ëÀå °Ô½ÇÀº pseudodiverticulumÀ̶ó ÃâÇ÷ºÎ ÇÏ´Ü¿¡ ±ÙÀ°ÃþÀÌ ¾ø¾î¼­ injection therapy, coagulation therapy, band ligation µî¿¡¼­ õ°øÀÌ ¹ß»ýµÇÁö ¾ÊÀ»±î °ÆÁ¤ÀÔ´Ï´Ù. (2) ClippingÀº ¾îµð¸¦ ¹­´Â´Ù´Â °ÍÀԴϱî?

[2017-6-12. ÀÌÁØÇà ´äº¯]

°Ô½Ç ÀÔ±¸°¡ ³Ð¾î¼­ °Ô½Ç ¹Ù´ÚÀÇ Ç÷°üÀ» ¹Ù·Î targetÇÏ¿© clipping ÇÑ °æ¿ìÀÔ´Ï´Ù.

°Ô½Ç ÀÔ±¸°¡ Á¼¾Æ¼­ ÀÔ±¸¸¸ Ʋ¾î¸·Àº °æ¿ìÀÔ´Ï´Ù.

°Ô½Ç¿¡ epinephrine injection ¶Ç´Â ÈíÀÎÇÏ¿© °Ô½ÇÀ» ¹ÝÀü½ÃÄÑ Ä¡·áÇÑ °æ¿ìÀÔ´Ï´Ù.

°Ô½Ç ÃâÇ÷ ¿¹¹æ¹ýÀº ¸¶¶¥Ä¡°¡ ¾ÊÀºµ¥¿ä, aspirinÀº ²÷À» °ÍÀº ¾øÁö¸¸ NSAID´Â ÁÖÀÇÇ϶ó´Â Á¤µµ·Î ÀÌÇØÇÏ¸é µÉ °Í °°½À´Ï´Ù.

°Ô½Ç ÃâÇ÷ÀÇ ´ëÇ¥ÀûÀÎ Ä¡·á¹ýÀº clippingÀÔ´Ï´Ù. ÃâÇ÷ °Ô½ÇÀÇ ÀÔ±¸°¡ ³Ð¾î °Ô½Ç ¹Ù´ÚÀ¸·Î Á¢±ÙÀÌ °¡´ÉÇÏ°í ÃâÇ÷Ç÷°üÀÌ º¸ÀÌ¸é ±× ºÎÀ§¸¸ targetÇÏ¿© clippingÇÏ¸é µË´Ï´Ù. ÃâÇ÷ °Ô½ÇÀÇ ÀÔ±¸°¡ Á¼¾Æ °Ô½Ç ¹Ù´ÚÀÌ º¸ÀÌÁö ¾ÊÀ¸¸é °Ô½Ç ÀÔ±¸¸¦ zipper fashionÀ¸·Î tightÇÏ°Ô multiple clippingÇÏ¸é µË´Ï´Ù. ÃâÇ÷Ç÷°üÀº ³öµÎ°í Ãⱸ¸¸ Ʋ¾î¸·´Â´Ù°í ÁöÇ÷ÀÌ µÇ´ÂÁö Àǹ®À» °¡Áö½Ã´Â °æ¿ì°¡ ¸¹Àºµ¥ ´ëºÎºÐÀÇ °æ¿ì¿¡¼­´Â ÁöÇ÷ È¿°ú´Â ÁÁ½À´Ï´Ù.

°Ô½Ç ÀÔ±¸°¡ ³Ð¾î¼­ °Ô½Ç ¹Ù´ÚÀÇ Ç÷°üÀ» targetÇÏ¿© clippin ÇÑ °æ¿ì (±Ýº¸¶ó. ´ëÇѳ»°úÇÐȸÁö 2013)

°Ô½Ç ÀÔ±¸°¡ Á¼¾Æ¼­ ÀÔ±¸¸¸ Ʋ¾î¸·Àº °æ¿ì (Digest Endos 2015)

ÃâÇ÷ºÎÀ§¸¸ ãÀ¸¸é ¾î¶°ÇÑ ¹æ¹ýÀ¸·Î Ä¡·áÇصµ È¿°ú´Â ¸Å¿ì ÁÁ½À´Ï´Ù. Injection, coagulation, band ligation¿¡¼­µµ õ°øÀÌ ¹ß»ýÇÏ´Â ¿¹´Â °ÅÀÇ ¾ø´Â ¸ð¾çÀÔ´Ï´Ù. ¾Æ·¡ Ç¥¸¦ Âü°íÇϼ¼¿ä. CoagulationÀ» Áö³ªÄ¡°Ô ÇÏÁö ¾Ê´Â ÇÑ Å« ¹®Á¦´Â ¾øÀ» °Í °°½À´Ï´Ù.

ÇÕº´Áõ ¹ß»ý·üÀÌ ¸ðµÎ 0%ÀÔ´Ï´Ù (Digest Endos 2015).

2013³â 10¿ù EndoTODAY¿¡¼­´Â °Ô½Ç ÃâÇ÷¿¡ ´ëÇÑ Åä·ÐÀ» ÁøÇàÇÏ¿´´ø ÀûÀÌ ÀÖ½À´Ï´Ù. CapÀ» ÀåÂøÇÑ ³»½Ã°æÀ¸·Î µé¾î°¡ ÃâÇ÷ºÎÀ§ °Ô½ÇÀ» »¡¾Æµé¿©¼­ °Ô½ÇÀ» µÚ¤¾î Ä¡·áÇÏ´Â ¼ú½ÄÀÌ ¼Ò°³µÇ¾ú½À´Ï´Ù. ±×¿¡ ´ëÇÑ ¿©·¯ ±³¼ö´ÔµéÀÇ ÀÇ°ßµµ ÀÖÀ¸´Ï ÇÔ²² Àо½Ã±â ¹Ù¶ø´Ï´Ù (EndoTODAY °Ô½Ç ÃâÇ÷¿¡ ´ëÇÑ Åä·Ð).


[2017-7-3. ¾Öµ¶ÀÚ Áú¹®]

°Ô½Ç ÃâÇ÷ ¿¹¹æ¹ýÀº ¸¶¶¥Ä¡°¡ ¾ÊÀºµ¥¿ä, aspirinÀº ²÷À» °ÍÀº ¾øÁö¸¸ NSAID´Â ÁÖÀÇÇ϶ó´Â Á¤µµ·Î ÀÌÇØÇÏ¸é µÉ °Í °°½À´Ï´Ù. °Ô½Ç ÃâÇ÷°ú °Ô½Ç¿°ÀÇ ¿¹¹æ¹ýÀº ´Ù¸¦ °Í °°½À´Ï´Ù. Á¦°¡ ±èÅÂÁØ ±³¼ö´ÔÀÇ <°Ô½ÇÃâÇ÷ ¿¹¹æ°ú ¾àÁ¦ ½½¶óÀ̵å> ±Ù°Å ³í¹®À» ÀÚ¼¼È÷ ¸ø º¸°í Àִµ¥, °Ô½Ç ÃâÇ÷°ú °Ô½Ç¿° °¢°¢¿¡¼­ aspirin°ú NSAIDs°¡ °¢°¢ Àç¹ß¿¡ ¹ÌÄ¡´Â ¿µÇâÀ» ´Ù½Ã ÇÑ ¹ø Á¤¸® ºÎŹµå·Áµµ µÉÁö¿ä?

[2017-7-5. ±èÅÂÁØ ±³¼ö´Ô ´äº¯]

939¸íÀÇ °Ô½Ç¿° ȯÀÚ¿Í 256¸íÀÇ °Ô½ÇÃâÇ÷ ȯÀÚ¸¦ 22³â ÃßÀû°üÂûÇÑ ¿¬±¸°á°ú(Gastroenterology 2011)¸¦ º¸¸é, °Ô½ÇÁúȯÀÇ ¿©·¯ À§ÇèÀÎÀÚµéÀ» º¸Á¤ÇÏ¿´À» ¶§ aspirinÀ» ±ÔÄ¢ÀûÀ¸·Î º¹¿ëÇÏ´Â »ç¶÷Àº ±×·¸Áö ¾ÊÀº »ç¶÷¿¡ ºñÇÏ¿© ÀÌÂ÷ °Ô½Ç¿° ¹ß»ýÀÇ ºñ±³À§Çèµµ´Â 1.25 (95% CI, 1.05-1.47), °Ô½Ç ÃâÇ÷ÀÇ ºñ±³À§Çèµµ´Â 1.70 (95% CI, 1.21-2.39) ·Î ´õ ³ô¾Ò½À´Ï´Ù. Nonaspirin NSAIDs º¹¿ëÀÚ´Â º¹¿ëÇÏÁö ¾ÊÀº »ç¶÷¿¡ ºñÇØ °Ô½Ç¿°ÀÇ ºñ±³À§Çèµµ´Â 1.72 (95% CI, 1.40-2.11), °Ô½ÇÃâÇ÷ÀÇ ºñ±³À§Çèµµ´Â 1.74 (95% CI, 1.15-2.64)·Î º¸°íµÇ¾ú½À´Ï´Ù.

°Ô½Ç¿°ÀÇ ÀÌÂ÷¹ß»ý À§ÇèÀº aspirin (RR:1.25) º¸´Ù NSAIDs (RR: 1.72)°¡ ´õ ³ô¾Ò°í °Ô½ÇÃâÇ÷ÀÇ Àç¹ß À§ÇèÀº µÎ ¾àÁ¦°¡ ¼­·Î ºñ½ÁÇÕ´Ï´Ù.(ASA: 1.70, NSAIDs: 1.74) °Ô½Ç¿° Àç¹ß¿¡ ´ëÇÑ aspirin ÀÇ ¿µÇâÀº ¾àÇϱ⠶§¹®¿¡ aspirinÀº À¯ÁöÇÏ´Â °ÍÀÌ ´õ ÁÁ°Ú°í NSAIDs´Â °Ô½Ç¿° ¶Ç´Â °Ô½ÇÃâÇ÷ ¿¹¹æÀ» À§ÇØ ²÷´Â °ÍÀ» °í·ÁÇØ¾ß ÇÕ´Ï´Ù. °Ô½ÇÃâÇ÷¿¡ ´ëÇÑ ºÎºÐÀº µÎ ¾àÁ¦°¡ ºñ½ÁÇÑ À§Çèµµ¸¦ º¸¿©ÁÖ¾úÀ¸³ª aspirinÀº ½ÉÇ÷°üÁúȯ¿¹¹æ¿¡ ´ëÇÑ À̵æ°ú Çظ¦ µûÁ® case by case ·Î ÆÇ´ÜÇØ¾ß ÇÒ °ÍÀÔ´Ï´Ù.


[FAQ]

[2017-3-4. ¸Þµð°ÔÀÌÆ® ´º½º] ¾Ï ¿ÀÁø Àǻ翡°Ô Ã¥ÀÓ ¹°Àº ¹ý¿ø - ÃæºÐÇÑ °ËÁõ ¾øÀÌ ¼­µÑ·¯ ¼ö¼úÇÑ °ú½Ç

À§¾Ï ¼ö¼ú ¸î ³â ÈÄ °Ô½Ç¿°(±â»ç¿¡¼­´Â °Ô½ÇÁõÀ¸·Î µÇ¾î ÀÖ½À´Ï´Ù¸¸)ÀÌ ¿Ô´ø ¸ð¾çÀε¥ Á¾¾çÀ¸·Î »ý°¢ÇÏ°í ¼ö¼úÇÑ ÀÇ·á±â°ü¿¡ ´ëÇÏ¿© ¹ý¿øÀÌ Ã¥ÀÓÀ» ¹°¾ú´Ù´Â ±â»çÀÔ´Ï´Ù. »ó¼¼ ³»¿ëÀ» ¾Ë ¼ö ¾øÁö¸¸ ¼ö¼ú Àü Áø´Ü°ú ¼ö¼ú ÈÄ Áø´Ü¿¡ Â÷ÀÌ°¡ ÀÖ´Ù´Â °ÍÀ» ¹ýÀûÀ¸·Î ÇØ°áÇÑ´Ù´Â °ÍÀº ¹Ù¶÷Á÷ÇÑ ÀÏÀº ¾Æ´Ï¶ó°í »ý°¢ÇÕ´Ï´Ù. ±â»ç¸¦ ¿Å±é´Ï´Ù.

"¹ý¿øÀº Á¾¾ç Á¦°Å ¼ö¼úÈÄ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ¾Æ´Ñ °ÍÀ¸·Î È®ÀÎµÈ »ç°Ç¿¡ ´ëÇØ ÀÇ·áÁøÀÌ ¼º±ÞÇÏ°Ô ¼ö¼úÀ» ¼­µÑ·¶´Ù¸ç ¼ÕÇعè»ó Ã¥ÀÓÀÌ ÀÖ´Ù°í ÆÇ°áÇß´Ù. A¾¾´Â 2013³â Kº´¿ø¿¡¼­ À§¾Ï Áø´ÜÀ» ¹Þ°í À§ÀåÀüÀýÁ¦¼ú°ú ºñÀåÀüÀýÁ¦¼ú ¹× Ç×¾Ï Ä¡·á¸¦ ¹Þ¾Ò´Ù. A¾¾´Â ÀÌÈÄ ¿ä¾çº´¿ø¿¡¼­ ¿ä¾çÇÏ´ø Áß º¹Åë, ¼Òº¯·® °¨¼Ò µîÀÇ Áõ¼¼°¡ ¹ß»ýÇØ ´Ù½Ã Kº´¿ø¿¡ ÀÔ¿øÇß´Ù. Kº´¿ø ÀÇ·áÁøÀº ±¹¼Ò Á¾¾ç Àç¹ß ¶Ç´Â ÀüÀÌ¿¡ ÀÇÇÑ ´ëÀå¾ÏÀ¸·Î Áø´ÜÇÏ°í °áÀå¾ÆÀüÀýÁ¦¼úÀ» ½ÃÇàÇß´Ù. ±×·±µ¥ ¼ö¼úÈÄ Á¶Á÷°Ë»ç¿¡¼­ ÀüÀ̾ÏÀÌ ¾Æ´Ï¶ó »óÇà°áÀå °Ô½ÇÁõ(»óÇà°áÀåÀÇ º®ÀÌ ¹Ù±ùÂÊÀ¸·Î µ¿±×¶þ°Ô ²Ê¸® ¸ð¾çÀ¸·Î Æ¢¾î³ª¿À´Â Áúȯ)ÀÎ °ÍÀ¸·Î Áø´ÜµÆ´Ù. A¾¾´Â ±¤¹üÀ§ÇÑ °áÀå ÀýÁ¦·Î ÀÎÇØ ¼ÒÈ­±â Àå¾Ö°¡ ÀÖ°í, ÇÏ·ç¿¡ 5~6¹ø ¼³»ç Áõ¼¼¸¦ º¸ÀÌ°í ÀÖÀ¸¸ç, ÈÄÁß°¨(º¯À» º¸°í ³­ ÀÌÈÄ¿¡µµ º¯ÀÌ ³²¾ÆÀÖ´Ù°í ´À³¢´Â °Í) Áõ¼¼°¡ ÀÖ´Ù. ÀÌ¿¡ ´ëÇØ ¼­¿ïÁß¾ÓÁö¹ýÀº Kº´¿ø ÀÇ·áÁøÀÇ °ú½ÇÀ» ÀÎÁ¤ÇØ A¾¾¿¡°Ô 3559¸¸¿øÀ» Áö±ÞÇ϶ó°í ÆÇ°áÇß´Ù. ¹ý¿øÀº "A¾¾´Â ÀÔ¿øÇÑÁö 3ÀÏ ¸¸¿¡ ½ÃÇèÀû °³º¹¼úÀ» ÇÒ Á¤µµ·Î À§ÁßÇÑ »óÅ¿´´Ù°í º¸±â ¾î·Æ´Ù"°í °­Á¶Çß´Ù. ½ÃÇèÀû °³º¹¼úÀ̶õ ±Þ¼º º¹ÁõȯÀÚ¿¡°Ô °Ë»çÇÒ ¿©À¯°¡ ¾ø°Å³ª È®Á¤ Áø´ÜÀÌ ¾ÈµÈ ä °³º¹Çϰųª ¾Ç¼ºÁ¾¾çȯÀÚ¿¡°Ô ¾î¶² Ä¡·á°¡ °¡´ÉÇÑÁö Áø´ÜÇÏÁö ¾ÊÀº »óÅ¿¡¼­ °³º¹ÇÏ´Â °æ¿ì, º¹ºÎÁúȯÀÇ ÀǽÉÀÌ ÀÖ¾î Áø´Ü ¸ñÀûÀ¸·Î °³º¹ÇÏ´Â °ÍÀ» ÀǹÌÇÑ´Ù. ¶Ç ¹ý¿øÀº "ÀÔ¿ø ´ç½Ã Ç÷¾×Á¾¾ç³»°ú¿¡ ÇùÁøÀ» ÀÇ·ÚÇÑ °á°ú Àç¹ßº¸´Ù´Â ´Ù¸¥ ¿øÀÎÀ» »ý°¢ÇؾßÇÑ´Ù´Â ´ä½ÅÀÌ ÀÖ¾úÀ¸¸ç, ºÒ°ú 4°³¿ù Àü À§¾Ï ¼ö¼úÀ» ÇÒ ¹«·Æ ¿ø°Ý ÀüÀ̳ª ±¹¼Ò ÀüÀÌ°¡ ¾ø´Ù´Â °Ô È®ÀÎµÈ »óÅ¿´´Ù"°í ȯ±â½ÃÄ×´Ù. ÃæºÐÇÑ °Ë»ç¿Í ¸é¹ÐÇÑ Áø´ÜÀ» ÅëÇØ ÀüÀÌ¾Ï ¿ÜÀÇ ´Ù¸¥ ¿øÀÎÀÌ ¾ø°Å³ª ¾Ï Àç¹ßÀÌ Æ¯È÷ ÀÇ½ÉµÉ ¶§ ½ÃÇèÀû °³º¹¼úÀ» ÇØ¾ß ÇÔ¿¡µµ ºñ¼ö¼úÀû ½Ã¼úÀ» ¼±ÇàÇÏÁö ¾Ê°í, ÃæºÐÇÑ °ËÁõ ¾øÀÌ À߸øµÈ Áø´Ü ¾Æ·¡ ¼º±ÞÇÏ°Ô °³º¹¼úÀ» Çß´Ù´Â °ÍÀÌ´Ù. ¹ý¿øÀº ȯÀÚ¿¡°Ô °áÀå Æó»öÀÌ ÀÖ¾î ³»½Ã°æÀû ½ºÅÙÆ® ½Ã¼úÀ» Çϸé õ°ø µîÀ» ÃÊ·¡ÇÒ ¼ö ÀÖ´Ù°í ÆÇ´ÜÇß´Ù´Â ÀÇ·áÁøÀÇ ÁÖÀåµµ ¹Þ¾ÆµéÀÌÁö ¾Ê¾Ò´Ù. ¹ý¿øÀº "¿ÏÀü Æó»öÀÌ ¾Æ´Ï¶ó¸é ´ëÀå³»½Ã°æ °Ë»ç°¡ Àý´ëÀû ±Ý±â»çÇ×ÀÌ ¾Æ´Ñ Á¡, ¾ó¸¶°£ÀÇ À§ÇèÀÌ ¼ö¹ÝµÇ´õ¶óµµ ³»½Ã°æÀû ½ºÅÙÆ® »ðÀÔ ½Ãµµ¸¦ Çغ¸°Å³ª °áÀå ³»°­ÀÇ »óȲÀ» Á¡°ËÇÒ ¼öµµ ÀÖÀ¸¸ç, ³ª¾Æ°¡ Á¡¸·ÀÇ Á¶Á÷°Ë»çµµ °¡´ÉÇÑ Á¡¿¡ ºñÃç ÁßÀçÀû ½Ã¼úÀ» ¸ÕÀú ½ÃµµÇÒ ¼ö ÀÖ¾ú´Ù°í º¸ÀδÙ"°í ÁöÀûÇß´Ù."

[2022-6-2] ´ëÇѼÒÈ­±âÇÐȸ ±³À°ÀÚ·á¿¡ ÀÌÅ»µÈ Çöó½ºÆ½ ´ãµµ¹è¾×°ü¿¡ ÀÇÇØ ¹ß»ýÇÑ ´ëÀå°Ô½Çõ°ø Áõ·Ê°¡ ¼Ò°³µÇ¾ú½À´Ï´Ù.


[References]

1) ½Äµµ °Ô½Ç: Zenker diverticulum, Killian-Jamieson °Ô½Ç, Áߺνĵµ °Ô½Ç, ÇϺνĵµ °Ô½Ç

2) À§ °Ô½Ç

3) ½ÊÀÌÁöÀå °Ô½Ç

4) Meckel °Ô½Ç

5) ´ëÀå °Ô½Ç°ú °Ô½Ç¿°

6) Diverticular diseases (2017-6-12. ¿ù¿ä¼ÒÈ­±âÁý´ãȸ ¹Ú¼º¿í)

7) ´ÚÅÍ ´Ü°¨ °Ô½Ç¿°

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